2012年12月9日 星期日

臺大醫院新舊址簡介[英文]


課程訓練部 醫學六 高瑞鴻 製作
GENERAL INFORMATION
NTUH was first established in 1895. The building of the hospital was originally wooden. In 1921, the west building was reconstructed as Renaissance style, which was the biggest and most modern hospital in the southeastern Asia. The east building was built in 1991, and the these two buildings were connected by “Jing-Fu tunnel” finished in the following years. Now the hospital has 27 medical departments , and about 6000 employees and 2400 beds, and the number of OPD visits are more than 8000 per day.

WEST BUILDING

The building of the hospital was originally wooden. In 1921, the west building was reconstructed. It was Baroque style from Renaissance era, which was biggest and most modern hospital in the southeastern Asia. The building has been well-preserved till now, and in 1998, it was listed as a historical site by the Taipei City government.
       
        Now this building is mainly for the out-patient services of more than 8000 visits per day.

EAST BUILDING

This was the new building of the hospital and opened in 1991. The building is connected with the medical school building, and now, it is mainly for the hospitalized patients.
At top of the lobby, there is a decoration of a centipede without head and tail. Because a centipede not only can live in this condition, but also is a kind of Chinese herb itself, it is a symbol of tough vitality and also a blessing for the patients here.

臺灣全民健保簡介[中文+英文]


臺灣全民健保簡介
課程訓練部 醫學六 高瑞鴻 製作

中文簡介 :

(選輯自維基百科)


全民健康保險,一般簡稱為「全民健保」或「健保」,是中華民國依據《中華民國憲法增修條文》所實施的全民醫療保險制度。第二次世界大戰結束後的台灣,原本只有勞工保險(勞保)、農民保險(農保)、公務人員保險(公保)等醫療保險,無法照顧到全體國民。為增進全體國民健康,台灣於19953月開始實施全民健康保險,以提供醫療保健服務,主要法律依據為《全民健康保險法》。
        全民健康保險唯一辦理及管理機構,是行政院衛生署下轄的中央健康保險局(簡稱中央健保局),為一官方機構。此種「公營單一社會保險制」的醫療照顧體系(health care system),則類似加拿大的制度。

台灣實施全民健保時,為了將公保、勞保、農保、軍保的舊有保險體系整合納入全民健保中,故而採取依身份別強制納保的制度。不同身份的加保人不因健康病史問題而有不同保費,而是根據行業身份而有不同納保費率。民眾加保後,以健保卡到醫療院所就醫時即僅須負擔掛號費以及部份負擔費用。而醫療院所則是以量計酬,根據病患病歷就診紀錄向健保局請領醫療給付。

但由於1995年實施全民健保後,醫療開支大幅增加,遠超過原核定保費所能支應。故而健保局引入健保總額支付制度來控制財務風險。亦即健保局不再全額給付醫療院所的醫療支出費用,而是在事前劃定一個醫療支出費用的總額,由醫療院所各自申請後,若申請總額低於原訂總額則全額給付,若申請總額高於原訂總額,則按比例打折給付。
直接優點:
若國民若身患重病,可以大幅減少家庭及個人財務負擔,尤其是在病患一旦罹患重症(例如癌症),除了少部份自費負擔外大多數醫療費用都有高額的補助。而健保平時也能補貼一般疾病的開支,減輕民眾醫療的負擔。也因此全民健保的滿意度一直是居高不下。
健保提供福利:
健保局公告癌症,先天性疾病...等等疾病為「重大傷病」,合乎規定的被保險人至健保合約醫療院所就醫時,得免繳交部分負擔。
健保附有免費健康檢查福利,唯宣傳較少不為一般大眾所知,在2400家參與免費健康檢查服務的診所或醫院,40歲以上每3年一次65歲以上每年一次可以要求免費健康檢查。檢查內容為身體檢查、健康諮詢、血液檢查、尿液檢查四項。
財務優點:
總額給付制把保險不給付的風險轉嫁給醫院,全民健保與商業保險一樣會找理由不給付,但是商業保險是由病患個人承擔保險公司不給付的風險,而全民健保則是由醫院先行承擔,政府不負擔此一風險,而病患則是在醫院無法吸收虧損後才承擔風險。
全民健保降低商業保險的需求,而許多商業保險公司會把保費拿來投資土地,造成都會區高地價高房價,形同國民付錢給保險公司炒地皮。全民健保可能可以減輕這樣的狀況。
從經濟學的觀點來看,民眾因為負擔減輕而有誘因增加醫療需求,醫院因為以量計酬而有誘因增加醫療開支,所以這個保險本身就有傾向過度成長的誘因。而由於保費的調漲又受到非經濟的政治力左右,使得保費的調漲困難,不能迅速反應醫療開支的增長。這兩個結構性的因素致使全民健保的財務問題始終在難以永續執行的破產邊緣徘徊。

醫療開支過度成長

針對醫療開支過度成長的問題,健保局引入健保總額支付制度來控制財務風險。亦即健保局不再全額給付醫療院所的醫療支出費用,而是在事前劃定一個醫療支出費用的總額,由醫療院所各自申請後,若申請總額低於原訂總額則全額給付,若申請總額高於原訂總額,則按比例打折給付。這個措施延緩了全民健保的破產危機,然而非經濟因素造成的財務問題卻還是無解。

保費結構不良

另外以身份別、納保薪資為基礎的保費結構延續了早年政府照顧勞工、農民、軍公教人員的政策,會產生保費偏低的問題,而已納保薪資為基礎的保費結構,使得以資本利得為主要收入的富人並未負擔較高的保險費用,形成由受薪階級負擔全民健康的不公平現象。為此健保局也規劃了一點五代健保及二代健保,期望能解決財務及公平問題。一點五代健保是延續身份別納保,但是增加以資本利得為基礎的補充健保費,將本來以薪資收入為保費基礎擴大為以個人收入為保費基礎。二代健保則是停止身份別納保的制度,改以家戶收入為保費基礎。這兩種改革方式都是以擴大保費基礎來增加保費收入。
但全民健保保費徵收方案無論是單純修訂費率調漲或是結構性改善的調整方案都難以被國會以及民眾接受。衛生署提出調漲健保費的建議或是健保改革草案,也不容易得到支持。例如前衛生署長李明亮調漲保費費率後辭職,前衛生署長楊志良也在通過二代健保草案後辭職。由此即可看出要推動調漲保費與改善財務結構的困難性。

ENGLISH INTRODUCTION

Taiwan’s national health insurance (NHI) is administrated by the government. NHI is a compulsory for all citizens from birth, and its coverage is now more than 99%. Mutual assitance is the central concept of NHI. Once people pay the relatively low premium on time, they can choose to visit any hospital and doctor if they need medical care. And they can have treatment with very low copayment. Therefore, Taiwanese people have a very good accessibility to the healthcare system. The patients don’t have to worry about going bankrupt due to medical bills.
For example, the patient only has to pay 350NTD for a hernia repair surgery. Very inexpensive!! Another example is that in the era before NHI, once the patient was diagnosed with ESRD, he may need to sell his house to collect the money for chronic hemodialysis treatment. But this is not the case now in Taiwan. This is the bright side of Taiwan’s NHI.
Although there are a lot of good things from NHI, there are also many problems in Taiwan’s healthcare environment.
Because of the low copayment, “doctor shopping” is commonly seen in Taiwan. Also, because of the great number of patients, it is often for a doctor to see more than 50 patients in one morning, sometimes even more than 100! The patient may has to wait for a long time and only has a few minutes to see the doctor.
NHI uses many methods to control the expense, such as global budget and peer scrutinizing to limit the growth of medical expenses. For medical staff, the workload is heavy but the salary is relatively low. In some specific medical specialties like internal medicine, surgery, OBGYN, and pediactrics, these core departments of medicine are not the first choice of young doctors anymore. In addition, lack of nurses is also a problem in many hospitals because of the disproportionate workload and pay.
Generally speaking, NHI has been very good for patients, but it also makes the healthcare environment more and more unfriendly for doctors and nurses and cause many other problems.

INTRODUCTION ADAPTED FROM WIKIPEDIA

The current health care system in Taiwan, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer compulsory social insurance plan which centralizes the disbursement of health-care funds. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004.[4] NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many health care providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government. In the face of increasing loss and the need for cost containment, NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002.
Even with all their success in their health care system, Taiwan has suffered some misfortunes. The government is not taking in enough money to cover the services it provides, so it is borrowing money from banks.[15] The revenue base is capped so it does not keep pace with the increase in national income. Premiums are regulated by politicians[16] and they are afraid to raise premiums because of voters. The country is slow at adopting technology except for drugs. There is a low doctor-to-population ratio resulting in too many patients depending on too few doctors. Patients visit the doctor more frequently causing doctors to keep visits short to about 2 to 5 minutes per patient.[17] There is no system to regulate systematic reporting of clinical performance, patient outcomes and adverse events.

2012年12月8日 星期六

Introduction of the Taiwanese Medical System[中文+英文]


課程訓練部 醫學六 丁鵬升 製作

台灣的醫學教育體制介紹

醫學教育制度概述:

        台灣的醫學系教育始於1897,至今已逾一百年。一直以來制度大致上是七年制,理想上前兩年為大學教育,三四年級為基礎醫學,五六年級為臨床醫學,七年級擔任實習醫師。並非全台灣的醫學系都是以這樣的制度施行,例如有一些醫學系會有一年半或兩年的實習。於西元2013年入學的新生將會改成6+2制度,因為如此一來最後會有兩年的實習時間,希望可以訓練出更能做一級照護的醫師。

里程碑:

1994全面施行小班教學與問題導向教學
1999醫學院評鑑委員會成立,以標準化全台醫學教育
2007開始推行醫學專業素養,開始效法美國ACGME的六大核心能力
2011開始推行在第二階段國家考試前進行標準化臨床考試(OSCE),各醫學系前後開始建立臨床技能中心來增進問診能力及各種醫療行為之練習
2013全台灣醫學系標準化為6+2制度,加強學士後醫學訓練

台灣大學醫學院近來的醫學教育改變

l   楓城利他獎的建立,鼓勵助人精神
l   醫學專業素養作文比賽
l   評分方式由百分制改為等第制
l   住院醫師申請審核條件降低成績比重
l   精簡課程並空出時間讓學生能培養多元能力
l   鼓勵學生公共事務參與

Introduction of the Taiwanese Medical System

Overview of Medical Education in Taiwan:

        Taiwan’s medical education began in 1897 and is over 100 years old now.  It has had a 7 year curriculum, during which ideally the first two years are undergraduate liberal arts education, the third and fourth years are basic medical science education, the fifth and sixth years are clinical science, and the seventh year is an intern doctor.  Students graduate with a Doctor of Medicine (MD) degree.  Starting from the year 2013, incoming students will have a 6+2 year curriculum, in which the first 6 years are oriented similarly as before and the last two years are Post Graduate Years; this change aims to increase primary care capabilities of medical school graduates.

Milestones:

1994: Small group teaching and Problem Based Learning curriculum were implemented nationwide
1999: The Taiwan Medical Accreditation Council was established and aims to standardize medical education in Taiwan
2007: Medical Professionalism and the Accreditation Council for Graduate Medical Institutions (ACGME) six core abilities were emphasized in clinical settings
2011: The Objective Structured Clinical Exam (OSCE) will be a requirement for the second step of Taiwan’s medical licensing exam.  Clinical skill centers were established by medical schools nationwide to improve patient contact abilities and adeptness in medical procedures
2013: Change to the 6+2 year program to improve primary care capabilities

Changes in Medical Education at NTUCM

l   Altruism award for undergraduates
l   Professionalism essay contest
l   Grading system: from percentage scoring to grade point scale
l   Residency application lowers emphasis on academic performance
l   Streamline formal curriculum and reduce formal curriculum hour to release time for students to develop broad competences
l   Encourage student participation in public affairs

An Introduction to Medical Campus


課程訓練部 醫學六 丁鵬升 製作

10 second Q&As

Q: What is the significance of National Taiwan University College of Medicine (NTUCM)?

A: NTUCM is the beginning of Western medical education in Taiwan.  It was founded in 1897 as the School of Medicine by the Japanese occupation and later was incorporated into Taipei Imperial University, one of the 7 Imperial Universities that were at the spearhead of academics in the Japanese Empire.  In 1971, the School of Medicine was incorporated into National Taiwan University College of Medicine, and it continues to be the beacon of medicine in the nation today.

Q: What is the curriculum at NTUCM?

A:
l   School of Medicine offers a 7-year courses leading to the degree of MD.
l   School of Dentistry offers a 6-year training leading to the DDS.
l   Schools that offer a 4-year training for the bachelor degree: School of Pharmacy (offers also a 6-year for PharmD Program), School of Nursing, School of Physical Therapy, School of Occupational Therapy, School of Clinical Laboratory Science and Medical Biotechnology
Extended Answer:
Taiwan’s medical education underwent two drastic changes first in 1950s and then in the 1990s.  Before the 1950s, the education system was grafted from the German model that focused on scientific theory and empirical science, and placed less emphasis on clinical teaching and individual students.  A student’s time was mainly spent in classroom lectures and laboratories.  In the 1950s after Taiwan was returned to the Republic of China, our former Deans Dr. Tu Tsung-Ming and Dr. Wei Huo-Yiao decided to change our medical education system towards the American system that emphasized more on clinical learning in addition to lectures.  Furthermore, several other Schools such as Public Health, Pharmacy, Dentistry, Nursing, Physical Therapy, Occupational Therapy, and Clinical Laboratory Sciences and Medical Biotechnology were established, which provides the College with a broader scope of studies.  In 1990s, due to the rapid technological advancements that led to an explosion of medical ethics and evidence based medicine since the 1970s, NTUCM began in 1992 the first problem based learning classes in Taiwan and this marked the second change that persists today.

Q: Who was the first Taiwanese NTUCM Dean?

A: Dr. Tu Tsung-Ming.  His name Tsung-Ming in Chinese literally means “smart”, so literally, his name is Smart Tu!  And indeed, he’s smart. He dedicated his time to research, especially the snake toxin.

Q: How is the Medical Campus organized?

A: The main building of the College of Medicine is situated on the South end of the East Wing of the NTU Hospital, closest to Chiang Kai Shek Memorial.  The first 5 floors are lecture halls, the medical library, student areas, student laboratories, and administrative offices.  From the 6th to 15th floors are the offices and laboratories of our graduate institutes.  The College of Public Health is an independent building located in the block diagonally behind the East Wing of the hospital to the northeast.  Beside the College of Medicine is the Medical Humanities Building, which used to be a lecture hall and offices in the School of Medicine.  There is a student gym located behind the East Wing of the hospital and it has indoor basketball/volleyball/badminton courts, outdoor tennis courts, outdoor basketball courts, and outdoor volleyball courts.

Q: Where do students and faculty go for meals?

A: There is a student cafeteria with faculty lounges on the second floor of the College main building called Apricot Garden.  There is also the basement 1st floor of the hospital that has a foodcourt.

Appendix:

Our 7 schools:

l   School of Medicinel   School of Pharmacy
l   School of Nursing
l   School of Clinical Laboratory Sciences and Medical Biotechnology
l   School of Dentistry
l   School of Physical Therapy
l   School of Occupational Therapy

Our 23 graduate institutes:

l   Anatomy and cell Biology
l   Biochemistry and Molecular Biology
l   Biomedical Engineering
l   Clinical Dentistry
l   Clinical Laboratory sciences and Medical Biotechnology
l   Clinical Medicine
l   Clinical Pharmacy
l   Forensic Medicine
l   Immunology
l   Genomic & Proteomic
l   Brain and Mind Sciences
l   Microbiology
l   Nursing
l   Molecular Medicine
l   Oral Biology
l   Occupational Therapy
l   Pathology
l   Pharmacology
l   Pharmaceutical Sciences
l   Physical Therapy
l   Physiology
l   Toxicology
l   Clinical Oncology

Our 28 Departments under School of Medicine

l   Anesthesiology
l   Anatomy and Cell Biology
l   Biochemistry and Molecular Biology
l   Dermatology
l   Emergency Medicine
l   Environmental and Occupational Medicine
l   Family Medicine
l   Forensic Medicine
l   Internal Medicine
l   Laboratory Medicine
l   Microbiology
l   Neurology
l   Obstetrics and Gynecology
l   Ophthalmology
l   Orthopedics
l   Otolaryngology
l   Parasitology
l   Pathology
l   Pediatrics
l   Pharmacology
l   Physical Medicine and Rehabilitation Physiology
l   Primary Care Medicine
l   Psychiatry
l   Radiology
l   Social Medicine
l   Surgery
l   Urology


The College of Medicine Building:

1st Floor: Main Hall, Anatomy Dissection Room, entrance to the Medical Library, passageway to the Student Activities Center and Auditorium, Lecture Halls
2nd Floor: Office of the Dean, 1st Conference Room, Office of International Affairs, Apricot Garden Restaurant, Student Area, Study Room, Discussion Rooms
3rd Floor: Office of the School of Medicine, Office of Student Affairs, Office of the Registrar, Parasitology and Histology Student Laboratories, Lecture Halls
4th Floor: Pathology Student Laboratory, Discussion Rooms, Lecture Halls
5th Floor: Computer room, Discussion Rooms, Biochemistry Student Laboratory, Office of Toxicology, Lecture Halls

Statistics for 2011:
396 Faculty, including 180 professors, 108 associate professors, 87 assistant professors, 21 lecterers
3174 Students, including 1872 undergraduates, 769 masters degree graduate students, 533 PhD candidates