Date and Time
May 6, 2009
1:30 PM - 3:00 PM

Availability
Open to the public
No RSVP required

Speaker
Chia-Ling Yang - J.S.M. Candidate 2009 in the Stanford Program in International Legal Studies at Stanford Law School

Since 1995, Taiwan has had a universal health plan run by the Bureau of National Health Insurance (NHI) with one of the highest patient satisfaction rates around the world. But in 2005, thousands of doctors marched in protest to demand the abolition of the Global Budget Plan - a payment system designed to contain costs which resulted in a deflation of medical service reimbursement fees given to doctors for medical services rendered to patients. Although NHI applies the same discount scheme to all physicians, the plan has elicited an array of responses.

This project investigated methods employed by physicians in Taiwan to protest what they see as unfair reimbursement for medical services under the government-run universal health plan. To discover why some doctors took their dispute to court while most chose informal methods like participating in the 2004-2005 global budget demonstration or using guanxi (connections, I surveyed a representative group of general practitioners in Taiwan and conducted interviews with salient examples of physicians. Survey results showed that most physicians found the NHI's policy on global budget issues unreasonable, and rates of dissatisfaction with reimbursement were as high as 80%.  Interestingly, although 53.4% of the subjects wanted to sue the NHI, only 10.8% eventually filed lawsuits.

By linear regression analysis, a correlation between physicians' past experience of suing the government and their participation in litigation against NHI regarding the 2004-2005 global budget disputes was found. Some doctors were "repeat players" in suing the government, while the majorities were "zero players" who never initiated litigation despite their strong motivation to fight what they perceived as unreasonable administrative decisions.  Based on information from interviews, this research not only studied the characteristics of "confrontational" and "harmony-preferring" physicians but also found that there are significant structural obstacles that hinder the "zero players" from accessing the administrative litigation system. Several policy suggestions are proposed to remove such hindrance, in the hope that Taiwan's rule of law will mature to the extent that citizens will have easier access to the legal system when they want to have grievances redressed.  This research contributes to the literature on revealing tensions between doctors and the state, doctors' approaches to the use of the legal system and the need for judicial reform in Taiwan.