A. Origin
Since March 1995, the National Health Insurance System has been carried out in Taiwan. It has been more than 12 years. In the National Health Insurance are high coverage rate, wide benefit packages, and low premium – which become crucial factors influencing Taiwan's markets of both medical insurance and medical service. There are two major problems as follows. One is to face the predicaments of shrinking budgets and insufficient resources. Taiwan's medical costs take up only 6.1% of GDP (Annual Report on National Health Insurance Expense, 2006), but covers all-inclusive medical services. So it is frustrating to the medical service industry. The other is the public's poor attitude. This is because premiums for the National Health Insurance are paid by all citizens. Easily obtaining medical care, they often take it as a trading behavior – exchanging products with money. In the past, medical care and health-related behavior were taken as being sublime and divine – which is now declining gradually in the mind of the public. To balance the financial pressure resulting from reimbursement of National Health Insurance, hospitals have tried to integrate with upstream and downstream medical institutes horizontally or vertically, or have joined the self-financed medical market. Such medical service industrialized trends lead the safeguard for quantity and quality control of medical costs, deployment of medical resources and medical service of National Health Insurance to face a harsh challenge.
Taiwan's medical service industry adopted "alliance with many to repel one's expansion" rather than "alliance with one to participate in its ascendancy" before the National Health Insurance started. The "alliance with many" strategy was used in order to pursue operational efficiency. However, since the National Health Insurance started, especially in the aspect of implementing a Global Budget Payment System, the medical service industry has proceeded with various kinds of cooperation, in order to survive or to strengthen market competitive ability to strive for budgets of National Health Insurance. Therefore, various kinds of cooperative approaches, such as strategic alliance, chain management, regional alliance, joint procurement, joint outpatient, contract agreement, etc. have been growing very quickly. This situation leads hospitals to proceeding towards maximization, privatization, and conglomeration and even towards unionism, in order to directly negotiate with and rival the medical-care monopoly buyer, the Bureau of National Health Insurance. Or, with decisions made through meetings, collective actions influencing market competition are advanced (for example, taking days off, joint outpatient treatment, etc.).
The medical service industry has features like professional autonomy, specific industrial attributes, and an incomplete competition market. Competition policy is always one of the most important economic policies in western countries. What needs to be regulated in the industry is an enterprise' anti-competitive behaviors which include monopoly, combination, concerted action, and etc. (Wu Ding, 2006: 13). The purpose for stopping these behaviors is to build up a fair and reasonable mechanism for marketing competition. Whether competition policy can be applied directly to industrialized but non-profit organizations, especially in the medical service industry, still remains controversial. This paper discusses the issue of competition policy from the angle of industrialized medical service.
B. Research Methodology and Procedure
This research's targets are public and private hospitals that are legally registered for the status claimed by Department of Health, Executive Yuan, R.O.C. In this research, the temporal dimension is based on researches related to Taiwan's health care policy (Jiang Dong-liang, 1999), to use 1971, the health-care competent authority, Department of Health, Executive Yuan, was established, and 1995, the National Health Insurance started, as a demarcation. Taking this temporal scope, this paper examines Taiwan's health-care policy and industrial development. In spatial dimensions, the market structure and competition of medical service industry in Taiwan are also brought into discussion. This paper collects documentary data, concerns social contents, and explore current medical service industrialized state. Then following it analyze the results. Besides, four seminars for focus groups are organized. Through gatherings of representatives of the medical service industry -- management staff in hospitals, experts and scholars, their operation and relevant professional experience are employed to proceed with assessment of the issues concerning competition policy.
C. Major Suggestions
(A) Separation between Charitable Hospitals and Profit-making Hospitals
From the viewpoint of medical service's factors -- procurement, supply, and price, medical market exists objectively. Criticism towards medical system can only occur when the medical service becomes excessively market-oriented and ignores charitable features of public medical care. In the positioning of charitable hospitals is to provide basic medical care to low-income, poor and specific people, and all operating cost should be paid by the government. On the other hand, profitable hospitals are set to offer higher quality medical service to customers. The governmental departments need to define a boundary between policies of charitable hospitals and profitable hospitals and then strengthen supervision in procedure, regulation, standard and control of the total quantity of medical service. Market mechanisms should be properly introduced, and any risk of monopolization should be prohibited.(B) Role of the Competent Authorities in Charge of Competition Law
Under the trends of medical service industrialization, the Competition Authority should take the experiences of advanced countries as references, harmony with Chinese-Taipei's conditions and marketing structure, and enhance stability and transparency in law implementation. The Competition Authority should play roles as a promoter to establish competition culture, a participant of regulatory reform movement, a consultant of competition policy and an executer of market competition regulation.(C) Coordination and Cooperation between the Competition Authority and the competent authority of Health
When derived problems occur from medical service industrialization, it is worthwhile thinking that what is more important---the ethical mission of medical care or competition policy regulation Taking general administration as a concern, the two competent authorities should coordinate and cooperate with each other.(D) The Government Should Discuss and Schedule Strategic Policies to Help Non-Profit Organizations to be industrialized Correctly and Efficiently.
Now non-profit organizations engaging in business behavior has already arisen many disputes and doubts. How the Government helps resolve such a problem and discuss and schedule policies to encourage these organizations to correctly and effectively proceed with industrialization becomes a challenge in implementing policies for the future.