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Progress Report Oral

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Title: Progress Report Oral


1
Progress Report ( Oral)
Speaker Chien-Jen Chen, Minister of Health Date
February 25, 2004/7/13
2
Introduction
Creating a healthier living environment Ensuring
the quality of healthcare services
3
Policy Achievements
  • Prevention and control of SARS, influenza and
    major infectious diseases
  • Sustainable development of the National Health
    Insurance system
  • Implementation of comprehensive medical care
  • Development of special healthcare service
  • Insurance of food and drug safety
  • Strengthening of public health education and
    health promotion
  • Promotion of technical development and
    international exchanges

4
Prevention and Control of SARS, Influenza and
Other Major Infectious Diseases
5
Ensuring the Effectiveness of SARS Prevention and
Control (1)
  • Establishing a mobilization system for the
    prevention and control of SARS
  • Setting up a fever monitoring and warning system
  • Managing SARS case reporting and epidemiological
    surveys
  • Strengthening of immigration screening,
    self-health management and house quarantine
    procedures
  • Establishing management and distribution systems
    for disease control materials (protective
    clothing, N-95 surgical masks, flat face masks)
  • Initiating a infectious disease prevention and
    control medical care network
  • Creating a platform for international cooperation
    and opening communication channels

6
Ensuring the Effectiveness of SARS Prevention and
Control (2)
  • Strengthening lab testing and protective
    procedures
  • In response to an incident of SARS infection in a
    testing lab, sterilization measures were
    strengthened at 10 labs contracted to carry out
    SARS testing.
  • A lab biosafety assessment committee and an
    inspection team for biosafety level 3 and level 4
    labs were established to strengthen inspection
    and management of lab safety.
  • P3 and P4 labs were temporarily closed, and a
    series of training courses was held to ensure
    that lab personnel are well versed in standard
    lab procedures.
  • WHO experts were invited to Taiwan to inspect six
    P2, P3 and P4 labs in early January 2004, and
    improvements were made in accordance with their
    suggestions.
  • Arrangements have been made for a second round of
    inspections, with the WHO experts to be joined
    this time by experts from the US CDC and Japans
    National Infectious Disease Research Laboratory.
    These experts will conduct onsite inspections of
    the above labs, which will be reopened after
    their safety has been verified (it is predicted
    that they will reopen in mid-March 2004).

7
Implementing Infectious Disease Prevention and
Control
  • Dengue fever prevention and controlWith the
    implementation of the 4-year Dengue Fever
    Prevention and Treatment Plan, local dengue fever
    cases fell from over 5,000 in 2002 to 86 in 2003.
  • Enterovirus prevention and controlMonitoring and
    health education was stepped up to reduce deaths
    among serious cases.
  • AIDS prevention and controlContinued efforts
    were made to strengthen health education and
    increase screening among high-risk groups. The
    rate of increase for HIV infection dropped from
    18 in 2002 to 9 in 2003.
  • Tuberculosis prevention and controlTB monitoring
    and testing capabilities were strengthened, a
    case follow-up management system was implemented,
    and reporting time was reduced from 44 days to
    1.7 days. Moreover, the sputum testing rate rose
    from 75 to 93, and the age-standardized
    treatment rate for rose to 84.66.

8
Influenza and Avian Flu Prevention and Control
(1)
  • With the expansion of influenza immunization
    programs for the elderly, the 65-and-over
    immunization rate rose to 69.1. The immunization
    rate for medical personnel was 92.1
  • Monitoring of flue-like cases
  • Influenza case monitoring in the Taiwan Area
    began in 1999. The most prevalent system is
    reporting of cases by sentinel doctors who base
    their diagnoses on sentinel symptoms with no
    testing involved.
  • At present, over 500 clinic doctors are
    voluntarily participating in the case reporting
    system During the most recent week (the fifth
    week of 2004), the average number of cases
    reported per doctor was 29.0.
  • There was a rise in cases during the last flu
    season, starting in late November 2002. After
    reaching a peak in January 2003, the number of
    cases gradually began to fall. Most recently,
    cases began to increase again in late November
    2003, but numbers were lower than in previous
    years.

9
Influenza and Avian Flu Prevention and Control
(2)
  • Influenza vaccines were allocated to major
    poultry producing counties in the south for use
    in immunizing poultry workers.
  • Health bureaus nationwide implemented health
    education programs for poultry workers.
  • The antiviral medication Tamiflu was purchased
    and stockpiled for use in large-scale flu
    epidemics. This medication will be made available
    as needed depending on epidemic conditions.
  • Educational materials on avian flu such as
    leaflets, VHS tapes and cassette tapes were
    produced for distribution to television, radio
    and print media, the general public, and incoming
    and outgoing travelers. Relevant information was
    also made available on the Center for Disease
    Control website for downloading by the general
    public.
  • A plan was implemented to encourage the
    establishment of private-sector vaccine producers.

10
Promoting Sustainable Development of the National
Health Insurance System
11
Caring for Disadvantaged Groups, Closing the
Health Gap
  • With the implementation of policies to protect
    the disadvantaged, the lower ones income, the
    higher ones NHI benefit/payment ratio.
  • With the amendment of the National Health
    Insurance Act, NHI premium relief was provided to
    70,000 individuals.
  • NHI self-payment premiums were waived for 31
    major illnesses and injuries, benefiting 640,000
    individuals.
  • An integrated delivery service (IDS) for
    healthcare payments was implemented in 48
    townships in mountain regions, providing
    subsidies of NT 2.1 billion for 3 million
    medical visits.

12
Family Sector NHI Benefits and Expenditures per
Person 2002 data
13
NHI Premium Subsidies and Assistance Measures for
Disadvantaged Groups
  • 1. Premium subsidies
  • Partial or full premium subsidies were
    provided to low-income households, middle and low
    income senior citizens 70 and over, the mentally
    or physically disabled, aborigines 20 and under
    and 55 and over, unemployed workers and 9/21
    Earthquake victims. In 2003, NT 5.7 billion in
    subsidies were provided to 990,000 people.
  • 2. Healthcare safeguard measures for
    disadvantaged groups
  • Relief loans In 2003, 24,000 loans were
    provided, totaling NT 1.45 billion.
  • Premium payment by installments In 2003, 24,000
    installment arrangements were made, covering a
    total of NT 2.92 billion.
  • Referral to social welfare organizations In
    2003, over 500 successful referrals were made,
    covering approximately NT 6 million.
  • Healthcare safeguard measures In 2003,
    approximately 2,000 assistance applications were
    processed, covering approximately NT 26 million.
  • 3. On June 18, 2003, the National Health
    Insurance Act was revised by presidential order
    to include a health insurance relief article to
    assist the economically disadvantaged in solving
    insurance coverage and medical care problems.

14
Handling Delinquent Payments from Local
Governments
  • Article 30, Paragraph 5 of the revised National
    Health Insurance Act states that any government
    entity that does not make subsidy payments by the
    required deadline shall be charged interest on a
    daily basis, and shall be dealt with in
    accordance with compulsory enforcement
    regulations.
  • All delinquent county and city governments aside
    from the Taipei and Kaohsiung city governments
    have presented payment plans.
  • On January 13, 2004, the debts of the Taipei and
    Kaohsiung city governments were turned over to
    the courts for compulsory enforcement.
  • Local government delinquent payments
  • As of the end of 2003, NT 3.95 billion was
    recovered.
  • Outstanding payments total 36.731 billion.

15
Safeguarding Patient Safety, Improving Healthcare
Quality
  • 1. A pilot program to increase medical
    payments for the five major diseases
  • (cervical cancer, breast cancer,
    tuberculosis, diabetes, asthma) was
  • implemented.
  • Over 1.22 million patients have benefited from
    this program.
  • 2. A pilot program for the NHI family doctor
    integrated care system was
  • implemented.
  • As of January 2004, 24 such programs were
    underway in 15 counties and cities.
  • 3. The revised National Health Insurance
    Payment Schedules went into effect.
  • It is estimated that this latest revision to
    payment schedules will result in an increase of 3
    billion payment points.
  • 4. Improved NHI drug coverage
  • The range of drugs covered by the National Health
    Insurance is being gradually expanded
  • Drug treatment for hepatitis B and C is now
    covered.

16
NHI IC Card Implementation Progress
  • Starting from January 2004, the National Health
    Insurance IC card went into full effect.
  • Implementation principles making medical care
    available to all, eliminating reimbursement risks
    for hospitals and clinics.
  • Since implementation, NHI IC card operations have
    run smoothly.
  • Supporting measures for exceptions to NHI IC card
    use
  • Individuals who have not yet obtained their IC
    cards have only to sign the Treatment Exception
    Register to receive treatment under the National
    Health Insurance system.
  • The small number of clinics that have yet to
    receive guidance in joining the NHI IC card
    system may apply for an exception to continue
    practicing.

17
Supporting Measures for the 2004 Hospital Budget
Global Payment System
  • Review of reasonable hospital outpatient loads,
    implementation of treatment categories
  • Continued promotion of payment schedule reform,
    improvement of critical care
  • Promotion of chronic illness prescriptions,
    reduction of redundant medical care
  • Strengthening of resource waste control
    mechanisms, promoting rational use of health
    insurance resources
  • Continued review of the soundness of
    inpatient/outpatient ratios set by hospitals
  • Promotion of hospital excellence plans and
    reshaping of hospital functions to ensure that
    hospitals fulfill the roles expected by society
  • Enabling co-management and ensuring that
    information and feedback are provided in a timely
    manner
  • Timely implementation of the hospital global
    budget specialized autonomous proxy system in
    accordance with administrative procedure law and
    government procurement law, thus encouraging the
    co-management of expenses

18
National Health Insurance Satisfaction
Survey (4/20/1995 12/19/2003)
19
In an article published in the May 2003 issue of
the prestigious journal Health Affairs, the
Princeton scholar Tsung-Mei Cheng praised
Taiwans National Health Insurance system as an
outstanding achievement, emphasizing its
following strengths
National Health Insurance Results
  • Universal coverage
  • A consistent approval rating of approximately 70
  • Comprehensive coverage range
  • Highly accessible treatment
  • Appropriate total medical expense control
  • Low costs and high care standards in comparison
    to other countries

20
Implementing Comprehensive Medical Care
21
Healthcare Resource Growth Status
(2003 target successfully met)
(2003 target successfully met)
Notes 1. This is a four-year project, with
measures and targets set in 2001. 2. The numbers
listed on this chart are for approved, in-use
beds. 3. 2003 targets for Western doctors and
critical beds were successfully met.
22
Medical Personnel Training and Planning General
Medical Training Program for Medical School
Graduates
  • Providing training in the areas of whole-person
    healthcare, medical ethics, evidence-based
    medicine, and infection control 1,427 doctors at
    94 hospitals have participated in this program.
  • Providing four levels of general medical training
    in a mentor training program 95 people have
    completed this training.

23
Ensuring the Quality of Healthcare Services
  • 1. Establishing a medical care environment that
    emphasizes patient safety
  • A patient safety committee was established in
    February 2003.
  • Safety education training classes were held for
    over 20 types of medical personnel. Over 3,000
    people attended these courses.
  • The Clinic Safety Procedure Reference Guide was
    promulgated on October 23, 2003.
  • 2. Assessment standards, assessment forms and
    information forms for the various categories of
    hospitals were revised.
  • 3. Crating a more sound Chinese medicine clinical
    education environment
  • Seven Chinese medicine clinical education centers
    were established.
  • Field investigations of 33 Chinese medicine
    hospitals and Chinese medicine hospital
    departments were carried out.

24
DOH-affiliated Hospitals
  • 1. Among the total of 34 DOH-affiliated
    hospitals, there are 21 general hospitals, 6
    branch hospitals, 5 psychiatric hospitals, 1
    leprosy hospital and 1 thoracic hospital.
  • 2. Operational efficiency was much greater in
    2002 than in 1999 (the year the new system was
    implemented)

Note Because the final accounts for 2003 were
not yet complete, figures from monthly accounting
reports were used.
25
Development of Health and Medical Information (1)
  • The Health Information Network was enhanced by
    upgrading dialup Internet connections at
    nongovernmental hospitals and clinics to ISDN
    64K. At present, an average of 1,300
    nongovernmental hospitals and clinics use this
    type of connection every month.
  • Network intrusion detection systems were
    installed at 30 DOH-affiliated hospitals to
    detect hacker activity and protect networks from
    hacker attacks.
  • Teleconferencing systems have been set up at 73
    health organizations, including county and city
    health bureaus, DOH-affiliated hospitals and
    designated SARS treatment hospitals, facilitating
    inter-organizational meetings.
  • A DOH medical information storage system with
    statistical analysis and trend forecasting
    capabilities was established.
  • The DOH developed and implemented an online
    application system covering 52 service items in
    such areas as medical affairs, pharmaceutical
    affairs and food sanitation, making it possible
    for the public to complete applications online,
    download forms and keep track of application
    status.

26
Development of Health and Medical Information (2)
  • Since its establishment, the Medical Care
    Certification Management Center has issued 45,000
    healthcare certification IC cards for use in
    electronic medical records, the Electronic
    Medical Record Index Center, birth reporting, and
    electronic document exchange systems.
  • 120 hospitals and clinics were chosen to
    participate in a program to promote the use of
    electronic medical records. To date,
    approximately 5,000 electronic files have been
    exchanged in 2,150 exchange sessions.
  • With the establishment of the Electronic Medical
    Record Index Center, patients will be able to
    gain access to their past medical records after
    presenting their NHI IC cards to medical
    personnel for verification. This system is now
    being brought online 195,661 entries have been
    added, and 964 entries have been accessed.
  • The Drug Interaction Database has been developed
    to enable hospitals, clinics and pharmacies to
    look up and download drug interaction
    information. During the testing stage, the
    Database has so far received 1,086 hits.
  • The Medical Care Resource Management and
    Geographical Distribution Information System has
    been developed to provide quick access to medical
    care resource distribution and usage information
    as an aid in decision-making. Plans are currently
    underway to provide education and training in the
    use of this system.
  • A preliminary announcement has been made about
    the Electronic Medical Record HL7/XML Referral
    and Proxy Testing Protocol, which will provide a
    standard for inter-hospital exchange of
    electronic medical records.

27
Developing Special Healthcare Services
28
Strengthening Medical Rescue and Response
Mechanisms
  • Eight hospitals were designated as poison and
    chemical emergency hospitals 23 hospitals added
    contamination control and protective equipment
    antidote reserves were created at 47 hospitals
    nationwide and four hospitals were designated as
    poison information and testing centers.
  • Seven hospitals were designated as nuclear
    disaster level 2 emergency hospitals, and six
    hospitals were designated as nuclear disaster
    level 3 emergency hospitals.

29
Strengthening the National Mental Health System
1. Expanding psychiatric manpower and facilities
2. In order to implement the post-SARS
revitalization of the mental health system, 72
hospitals and county/city mental health centers
were chosen to provide mental rehabilitation
services. As of the end of 2003, such services
had been provided to 128 SARS patients, 158 house
quarantine patients and 9 family members of SARS
patients.
30
Developing Sound Long-term Care Services and
Rehabilitation for the Mentally and Physically
Disabled
Enhancing medical care resources for the elderly,
long-term care and childrens early intervention
31
Improving Healthcare Facilities in Mountain
Regions, Offshore Islands, and Aboriginal Areas
  • A healthcare equipment guide for mountain regions
    and offshore islands was created.
  • 715 subsidies have been provided to health
    departments in mountain regions and offshore
    islands for the purchase of emergency medical
    equipment the facilities at 26 health stations
    in mountain regions and 6 in the offshore islands
    have been upgraded.
  • Community health promotion plans have been
    implemented in mountain regions, outlying
    islands, and aboriginal areas. As of the present,
    58 community health building centers had been
    established.

32
Ensuring Food and Drug Safety
33
Creating a Sound New Drug RD Environment
  • To establish a clinical research environment and
    spur development in the biotech sector, six
    clinical trial centers for Western drugs and nine
    clinical trial centers for Chinese medicine have
    been established.
  • Inspections conducted at the various Chinese
    medicine clinical trial centers showed that all
    of the centers are capable of independently
    conducting testing in accordance with GCP
    standards.
  • The Taiwan Chinese Herbal Medicine Clinical Trial
    Environment and Testing Regulations were
    published.
  • Chinese medicine clinical trial personnel
    training courses were held, with 1,052 people
    attending.
  • 137 new drug RD counseling and guidance sessions
    were held for pharmaceutical manufacturers.
  • Establishing an adverse drug reaction reporting
    system
  • As of December 2003, 6,410 cases of adverse
    reactions to on-the-market drugs were reported.

34
Simplifying the new drug approval system
  • The approval process has been shortened to
    approximately 80 days .
  • An Approval Time Comparison between Taiwan and
    Other Countries (2002)

35
Strengthening Safety Management for Chinese
Medicine
  • The use of five Chinese medicine materials
    containing aristolochic acid (fangchi root,
    aristolochia root, Manchurian dutchmanspipe stem,
    dutchmanspipe fruit and dutchmanspipe vine), as
    well as products containing these materials was
    prohibited, and 50 related permits were
    cancelled.
  • Completion of the Dictionary of Chinese
    Pharmacopia Medicine (draft form) was announced.
  • Heavy metal standards for eucommia bark and six
    other Chinese medicine materials (cadmium
    lead

36
Creating GMP Management Mechanisms for Drugs
  • 1. Local
  • In 2003, follow-up inspections of 101 GMP
    pharmaceutical factories were carried out.
  • Promoting cGMP standards In 2003, 124 factories
    passed the second stage of the validation
    process, and 4 passed the third stage. ?
  • 2. Foreign
  • First stage validation for foreign pharmaceutical
    manufacturers 826 evaluations were conducted in
    2003.
  • GMP evaluations of foreign pharmaceutical
    manufacturers 2 evaluations were carried out in
    2003.

37
Raising Health Bureau Food and Drug Testing
Standards
  • In the interests of bringing the capabilities of
    testing labs at local health bureaus up to
    international standards, in 2003 42,856 food
    tests were carried out at health bureaus across
    the country. These tests were divided into 12
    categories, including chemical additives and
    microbes.
  • Guidance was provided to health bureaus in
    applying for Chinese National Laboratory
    Accreditation. Nine health bureaus received CNLA
    accreditation in 2003, and 18 health bureaus have
    received accreditation to date.

38
Consumer Protection Risk Management
  • 1. Promoting licensing for pharmacy personnel
  • The licensing target for pharmacy personnel was
    raised from 20 to 80.
  • 2. Promoting hospital and clinic drug labeling
  • New drug labeling standards include 13 required
    items and 3 suggested items.
  • These standards were initially implemented at 18
    hospitals, and later at 40 more hospitals and
    clinics, and 400 community pharmacies, for a
    total of 20 million labels.
  • 3. Promoting the comprehensive development of
    community pharmacy services
  • In the spring semester of 2003, 51 drug
    information courses were held at 50 community
    colleges, with a total attendance of 1,983.
  • The DOH advocated the establishment of community
    pharmacies to meet the needs of families in each
    neighborhood.
  • 4. Policing of false advertising 1,777 drug
    advertising violations, 1,184 food advertising
    violations, and 434 Chinese medicine advertising
    violations were uncovered.

39
Controlled Drug Management
  • Implementing a controlled drug licensing system
  • Amendments were made to controlled drug
    management regulations.
  • Organization and enterprise registration
    management By the end of 2003, 11,659
    registrations had been issued to organizations
    and enterprises, and registrations for 31,332
    individual users were being managed.
  • The average waiting period for issuing of
    controlled drug permits dropped from 4.6 days in
    2002 to 4 days.
  • Strengthening controlled drug inspection and
    control Online filing of controlled drug revenue
    and expenditure figures was implemented.
  • Strengthening substance abuse management
  • 13 drug testing organizations have received
    approval to conduct urine drug tests.
  • A total of 2,130 samples were sent for drug
    testing.
  • Enhancing the Controlled Substance Abuse
    Reporting Information System 96 medical care
    institutions were added to the list of reporting
    units.


40
Ensuring Food Safety (1)
  • Food manufacturer self management for sanitation
  • 1. Encouraging sanitation self-management among
    manufacturers
  • A food safety control system for the fishing
    product industry was announced.
  • 2. Implementing GM food management
  • 11 GM soybean and corn products underwent the
    inspection and registration process.
  • 408 products underwent market monitoring and
    investigation.
  • A GM foods website was established, and has
    received approximately 580,000 visitors.
  • 3. Strengthening health food management
  • 40 products received approval.
  • A law amendment bill has been drafted, and is
    currently under review.

41
Ensuring Food Safety (2)
  • Strengthening food sanitation
  • Preventing food poisoning Guidance was provided
    to 171 take-out food enterprises (45 of a total
    382 take-out food enterprises) and 64 food and
    beverage service enterprises, a total of 235
    enterprises, in applying for preliminary
    certification under the food safety control
    system.
  • Guidance and inspections for producers of Chinese
    New Year food products Out of the 433 producers
    subjected to inspection, 6 were found to be in
    violation of sanitation standards. These
    producers all met the compliance deadlines eight
    products were spot checked, and were all found to
    be up to standard.
  • Promoting a nutrition labeling system
  • Nutrition labeling will be implemented in stages
    for the following food product categories dairy
    products, cooking oil, frozen foods, baked goods,
    grain products, canned goods, and candy. 23
    instruction sessions have been held for
    manufacturers.
  • Inspecting food products on the market has become
    part of regular health bureau operations.

42
Strengthening Health Education and Health
Promoting
43
Promoting National Health (1)
  • 1. Prevention and control of major diseases
  • In the interests of actively promoting cancer
    prevention and control, the Cancer Act was passed
    on May 21, 2003.
  • The three-year pap smear rate for women 30 and
    over has risen to 53.5.
  • The standardized cervical cancer death rate fell
    from 7.0/10,000 people in 1991 to 4.9/10,000
    people in 2002.
  • 160,000 women aged 50 and over have undergone
    breast cancer screening, and 190,000 betel nut
    users have undergone oral cavity cancer
    screening.
  • Promoting hypertension and diabetes prevention
    and control, and pilot programs for stroke,
    asthma and kidney disease
  • 17counties and cities have implemented
    comprehensive preventative healthcare services,
    raising the adult testing utilization rate to
    40.
  • A coverage rate of 89 was achieved for diabetes
    shared care programs, and 240 diabetes support
    groups were established.
  • 188 health promotion organizations for asthma and
    other diseases were established.
  • 2. Promoting comprehensive tobacco hazard control
    measures
  • Creating a smoke-free environment 175 schools,
    770 restaurants and 160 workplaces are now
    smoke-free.
  • Providing quit-smoking services Assistance has
    been provided to 33,227 people, and a six-month
    smoking cessation rate of 24.8 has been
    achieved.
  • Strengthening law enforcement In 2003, 495,614
    inspections were made, and 28,363 violations were
    recorded since the Tobacco Hazard Violation
    Complaint and Processing Center was established,
    425 complaints have been received.

44
Promoting National Health (2)
  • 3. Building healthy communities
  • 256 community health building centers have been
    established, as well as four healthy communities
    that meet WHO standards.
  • Plans to create healthy environments and living
    spaces have been implemented in 31 communities.
  • 4. Safeguarding womens and childrens health
  • A nationwide genetic health service network was
    established to provide care for newborns with
    rare diseases.
  • The newborn inherited metabolic disorders
    screening rate has risen to 99.8, and
    abnormalities have been detected in 3,468
    newborns.
  • In the interests of providing better care for
    foreign spouses and their children, healthcare
    manuals have been produced in four foreign
    languages.
  • Creating an environment more conducive to
    breastfeeding
  • In 2003, 74 medical care institutions received
    mother-and-infant-friendly certification.
  • The birth-to-one-month breastfeeding rate at
    these institutions rose to 75.05
  • With the promulgation of the Oral Health Act in
    May 2003, active steps have been taken to promote
    oral health
  • 1,830,000 children have benefited from a
    program to provide anti-cavity fluoride mouthwash
    at primary schools, a penetration rate of 98.

45
Promoting National Health (3)
  • 5. Strengthening nutrition education
  • In coordination with the Challenge 1,824 plan,
    385 registration booths were set up, and 3,903
    educational events were held, with an overall
    attendance of 470,350.
  • 200 food and beverage enterprises participated in
    this seasons program to promote healthy diets, a
    9.3 increase over last seasons 183 enterprises.
  • To enhance health education, information about
    the nutrition labeling system was made available
    online.

46
Promoting National Health (4)
  • 6. Establishing a model for health promotion
    schools
  • The DOH cooperated with the education sector to
    produce a health promotion school guide, and
    coordinated with the Ministry of Education to
    make health promotion schools a policy priority
    in 2003.
  • An international symposium on health promotion
    schools was held, with 13 experts from the US, UK
    and Germany attending. Participants included
    personnel from county and city health bureaus,
    education departments and schools.
  • A teachers health education information platform
    was established, and this information was
    combined with 1-9 grade health and physical
    education teaching materials to create an online
    resource website. As of January 31, 2004, this
    website had received 120,000 visits.

47
Promoting National Health (5)
  • 7. Implementing youth health education
  • Training youth volunteers to provide service in
    schools and communities In 2003, 87 health
    ambassador teams were trained, and 957 volunteers
    performed health service work. Services were
    provided to 87,900 people.
  • Drug abuse prevention training was held at
    teachers colleges. 96.3 of participants felt
    that the knowledge provided would be useful in
    drug abuse prevention.

48
Establishing an Effective Health Education Model
  • Promoting diversified health education
  • The Health 99, Health Education Resource Center,
    and Youth Health websites were brought online.
  • A variety of health education activities were
    held to raise public awareness of health issues.
  • Community, school, and medical care institutions
    resources were used to educate the public on
    health issues.
  • Developing an integrated model for health
    education media
  • In 2003, 17,923 television time slots, 13,410
    radio time slots, 56 outdoor advertisements
    (light box signs, bus advertisements), 282 print
    media advertisements (newspapers, magazines), and
    31 Internet advertisements (including cell phone
    ads) were centrally purchased, thus saving nearly
    57 in advertising costs.
  • A flexible communication model was established to
    respond to emergency needs. During the SARS
    outbreak, media and advertising channels
    nationwide were rapidly mobilized, and the
    efforts of the various government bodies were
    coordinated, thus making it possible to
    disseminate comprehensive SARS information.
    According to a public opinion survey conducted by
    the Research, Development, and Evaluation
    Commission, the public approval rating for SARS
    prevention and treatment was 81.1.

49
Development Promoting Technological and
International Exchange
50
Technological Development (1)
  • Enhancement of mid-term technology planning As
    part of seven national-level plans, 714
    technology research plans in such areas as
    medicine, drugs, food products and biotechnology
    were set into motion.
  • A new research report archive search website was
    established to provide both the general public
    and researchers with quick and convenient search
    capabilities.
  • Subsidies were provided for the holding of
    technology seminars both locally and abroad (113
    seminars were held, with attendance of over
    26,000).
  • The National Health Policy Conference was
    convened, with proceedings to be used in the
    drafting of future health policy.

51
Technological Development (2)
  • Cancer research Over 20 interdepartmental
    research projects have already been completed,
    and plans are underway for third-stage clinical
    trials of thalidomide and the breast caner drug
    Herceptin. In view of the high levels of liver
    cancer in Taiwan, a research study of
    post-operative treatment for liver cancer is
    currently being conducted. This study is the
    largest of its type in the world, and its results
    should be of great benefit in the post-operative
    rehabilitation of liver cancer patients.
  • SARS research The current project to develop
    quick and effective testing methods can help
    reduce the numbers of both false-positive
    diagnoses and false-negative test results. The
    results of this project have already been
    accepted for publication in the journal, Clinical
    Infectious Disease.
  • Genome Medicine research Genome sequencing teams
    from the National Yang Ming University, National
    Cheng Kung University and the Industrial
    Technology Research Institute worked together to
    successfully complete sequencing and analysis of
    the 5,280,000 base pairs of the Vibrio vulnificus
    bacterium. Their results, a first for Taiwanese
    researchers, have been published in the journal,
    Genome Research.

52
Technological Development (3)
  • New drug RD Research has been undertaken to
    develop new drugs to fight enteroviruses,
    hepatitis C and SARS. An anti-enterovirus drug
    developed through this research has already
    received a US patent, and animal model testing is
    being planned. Clinical trials have begun on an
    anti-hepatitis C drug, and patent applications
    have been filed for an anti-SARS drug, which will
    soon begin clinical trials.
  • Vaccine research The receptor binding sites on
    the SARS coronavirus S protein has been
    successfully determined. A US patent application
    has already been filed for these research
    findings.
  • Biostatistics and bioinformatics research The
    National Health Survey Information Management
    Center has been established, and is cooperating
    with the Stanford University in conducting an
    international research project on hypertension
    and insulin genes in the Asia-Pacific region.
    This project has already progressed to studying
    the relationship between the disease and specific
    genes.
  • The results of the 2001 Taiwan Area National
    Health Survey were made public, providing the
    various sectors with comprehensive and valuable
    national health information.

53
Technological Development (4)
  • Research results and technology transfers
  • Research papers From 2002 to the present, over
    251 papers have been published.
  • Patents
  • four patents were obtainedone in Taiwan and
    four in the US.
  • 54 patents are in the application stage19 in
    Taiwan, 29 in the US and six in other
  • countries
  • Technology transfers six technology transfer
    agreements are in effect
  • Industry-academic cooperation
  • there were 17 industry-academic cooperation
    projects, 28 academic-research
  • cooperation projects, and three international
    cooperation projects.

54
Promoting International Health Exchange
  • At the Asia Pacific Economic Cooperation (APEC)
    Conference, the APEC Health Task Force (HTF) was
    promoted and established.
  • Such international organizations as APEC, the
    Asian Development Bank (ADB), the Pan American
    Health Organization (PAHO), the European Health
    Forum in Gastein, and the West African Health
    Organization (WAHO) were used to promote
    bilateral talks and expand cooperation and
    exchange.
  • Cooperation and aid programs in Central and South
    America, Africa, Asia and the Middle East in such
    areas as infectious disease prevention and
    control and the establishment of health
    information systems were actively promoted. A
    present, nine health cooperation and exchange
    programs are operating in seven countries, and
    medical and material aid programs are operating
    in four countries.
  • A cooperation memorandum was signed with Japans
    National Institute of Infectious Disease.
    Bilateral or multilateral research data exchange
    or cooperation programs were established with the
    UKs Health Protective Agency (HEPA) and the EU
    6th Scientific Framework Programmes 6-country
    SARS Joint Research Team. In addition, channels
    for the ongoing exchange of epidemic data were
    established with the WHO, WPRO, APEC and the
    national health departments in the US, Singapore
    and Hong Kong.
  • In the interests of strengthening cooperation
    with major international organizations, guidance
    was provided to help local NGOs participate in
    aid activities sponsored by international NGOs.
  • Efforts were made to foster international health
    professionals.

55
Progress in Promoting WHO Membership
  • The WHO passed the SARS Resolution, providing
    Taiwan with new points of contact.
  • Taiwan has received increased support from the
    governments of many countries.
  • International medical and health organizations
    have issued public statements of support.
  • An international health cooperation plan was
    implemented.
  • Prompt reporting on Taiwans efforts has appeared
    in the international media.
  • A website about Taiwans WHO bid was established.

56
International Health Cooperation Plans
57
Future Prospects
Prospects for 2004 --
Cherishing Life, Investing in Health
58
Strengthening DOH Operations and Increasing
Service Efficiency (1)
  • In order to strengthen quarantine, laboratory
    testing and disease monitoring functions, the
    organizational statutes of the Center for Disease
    Control will be revised.
  • In the interests of getting more scholars,
    experts and infection control doctors involved in
    disease control, the personnel system will be
    made more flexible, and more opportunities for
    advancement will be opened up.
  • A unified food and drug administration system
    will be established.

59
Strengthening DOH Operations and Increasing
Service Efficiency (2)
  • The DOHs Bureau of Medical Affairs and the
    Central Taiwan Office will be transformed into
    the Bureau of Medicine and the Bureau of
    Healthcare Development, respectively. In the
    interests of strengthening international
    cooperation, a Bureau of International
    Cooperation and Representatives will be added. A
    Health Police unit will also be added to enhance
    inspection and seizure capabilities.
  • At DOH-affiliated hospitals, regional alliance
    self-management arrangements are being expanded,
    management structures are being streamlined, and
    regulations are being examined and revised, which
    will result in annual reductions in personnel
    subsidies of 5-10.

60
Strengthening DOH Operations and Increasing
Service Efficiency (2)
  • Reorganization of the National Health Insurance
    system At the end of June 2004, the Executive
    Yuans 2nd generation NHI planning committee will
    present its planning results. These results will
    be used as a reference in devising measures for
    reorganization of the Bureau of National Health
    Insurance and its related committees, and for
    planning an appropriate timetable and legal
    revisions.
  • Mechanisms for interdepartmental cooperation on
    health issues (SARS, AIDS, suicide prevention,
    policing of false advertising, strengthening of
    sex education, better protections for
    disadvantaged groups) will be strengthened and
    expanded.

61
Cherishing Life, Placing Value on Preventive
Healthcare (1)
  • Cherishing life was chosen as the central
    health education theme for 2004. Under this
    theme, the following areas are being emphasized
    health fitness, healthy diet, youth sex
    education, AIDS prevention and control, cancer
    prevention, and proper drug use, etc. Goals are
    as follows
  • Achieving a 10 increase in the public acceptance
    rating of the DOHs health education messages.
  • Expanding youth sex education promoting healthy
    relations between the sexes, achieving a sex rate
    of under 13.9 among high school students,
    promoting safe sex, achieving a birth control
    rate of 44 for first sexual intercourse.
  • Raising six-month smoking cessation numbers to
    10,700 people.
  • Achieving three-year pap smear numbers of
    3,330,000 among women 30 and over, or a pap smear
    rate of 54, and drafting the National Cancer
    Prevention and Control 5-year Plan.

62
Cherishing Life, Placing Value on Preventive
Healthcare (2)
  • Strengthening suicide prevention efforts
  • Plans are underway to establish a national
    suicide prevention center and strengthen
    community mental health education.
  • There are also plans to establish an
    interdepartmental (Ministry of the Interior,
    Ministry of Education, Council of Labor Affairs,
    Department of Health, and Government Information
    Office) suicide prevention taskforce.
  • Building healthy communities, protecting womens
    and childrens health
  • Providing guidance to 20 communities in creating
    healthy environments and living spaces
  • Designating 30 schools as health promotion
    schools
  • Certifying 80 hospitals as mother and infant
    friendly
  • Raising birth-to-one-month
    breastfeeding rates at these hospitals to 77
  • (and raising the national
    birth-to-one-month breastfeeding rate to 52)
  • Achieving penetration rate of 98.5 for
    anti-cavity fluoride mouthwash in primary schools
    nationwide

63
Cherishing Life, Placing Value on Preventive
Healthcare (3)
  • 4. Preventing diseases
  • Funds will be invested to strengthen breast
    cancer and cervical cancer screening (NT 450
    million and NT 800 million, respectively).
  • Preventive dental care for children will be
    enhanced, and the number of preventive dental
    visits for children six and under will be
    increased from six to nine.
  • 5. Preventing small illnesses from becoming major
    health problems NT 600 million will be invested
    in expanding the Family Medicine Integration
    Plan.
  • 6. Preventing major illnesses from worsening
  • The pilot program to increase medical payments
    for the five major diseases (cervical cancer,
    breast cancer, tuberculosis, diabetes, asthma)
    will be continued.
  • This program will be expanded in 2004 to include
    schizophrenia, hypertension and early
    intervention.

64
Cherishing Life, Placing Value on Preventive
Healthcare (4)
  • 7. Improving preventive healthcare Efforts will
    be made to increase NHI participation to nearly
    100.
  • 8. Strengthening healthcare for Taiwanese
    businesspeople on mainland China
  • In view of the special medical care needs of
    Taiwanese businesspeople in mainland China,
    attempts will be made to establish contracts with
    mainland hospitals for treatment of Taiwanese
    businesspeople and their dependants under the NHI
    system.
  • In the future, the enhancement of medical care
    resources and construction of higher-level
    hospitals in the Kinmen-Matsu Area will provide
    more treatment options for Taiwanese
    businesspeople residing in the coastal areas of
    Fujian Province.
  • 9. Reducing waste of healthcare resources The
    NHI IC card will be used to prevent inflated
    reporting of fees.

65
Freeing People from the Fear of Disease,
Establishing an Infectious Disease Medical Care
Network
  • Improving the hospital infection control system
  • At 22 designated hospitals, personnel will be
    provided with enhanced infection control
    training, and negative-pressure rooms and
    quarantine procedures will be established.
  • NHI payment schedules will be revised, and an
    assessment and incentive scheme for infection
    control quality standards in hospitals and
    clinics will be implemented.
  • Community fever monitoring will be strengthened,
    immigration screening measures will be enhanced,
    and an effective case follow-up system will be
    established.
  • A medical care system for coping with SARS and
    other emerging and reemerging infectious diseases
    will be established.
  • Lab equipment and testing capabilities and
    quality will be improved.
  • An disease control materials management plan will
    be established.

66
Emphasizing Whole-person Healthcare, Enhancing
Care Quality (1)
  • 1. Establishing a hospital accreditation system
    that emphasizes care quality and community
    medicine
  • The hospital accreditation system will be
    reformed to emphasize process and results rather
    than structure. Stress will be placed on patient
    safety, whole-person education and medical
    ethics, infection control, crisis management,
    prevention of medical errors, and guidance and
    protection of medical and nursing students.
  • The 2004 hospital accreditation and teaching
    hospital accreditation procedures and standards
    have been announced, and 184 hospitals have
    applied.
  • A regular but unscheduled accreditation
    follow-up system went into full effect, and will
    perform follow-ups on an estimated 120 hospitals.

67
Emphasizing Whole-person Healthcare, Enhancing
Care Quality (2)
  • 2. Implementing a general medical training
    program for medical school graduates
  • The goal of this program will be to provide
    training in the areas of whole-person healthcare,
    medical ethics, evidence-based medicine and
    infection control.
  • It is estimated that approximately 100 hospitals
    and 1,450 doctors will participate in this
    program.
  • A mentor training program was also established
  • 95 mentors were trained in 1993, and 150
    in 1994, a total of 245.
  • 3. Promoting the pilot program for the NHI family
    doctor integrated care system
  • It is estimated that in 2004 the program will be
    expanded to 200 locations.

68
Emphasizing Whole-person Healthcare, Enhancing
Care Quality (3)
  • 4. Establishing a medical care environment that
    emphasizes patient safety
  • Creating a patient-oriented medical care
    environment
  • In the interests of implementing safe operating
    standards in hospitals, hospital safety
    guidelines have been drafted.
  • A medical error reporting system that does not
    emphasize punishment will be established.
  • 5.Continued promotion of the Chinese medicine
    clinical teaching environment
  • In 2004, two hospitals were commissioned to
    implement the Establishing an Integrated Chinese
    Medicine Clinical Teaching SystemChinese
    Medicine Hospitals plan, and nine hospitals were
    commissioned to implement the Establishing an
    Integrated Chinese Medicine Clinical Teaching
    SystemChinese Medical Consultation plan.

69
Establishing a Unified Food and Drug
Administration System to Protect Public Safety
(1)
  • 1. Raising health bureau food and drug testing
    standards
  • In 2004, guidance will be provided to four health
    bureaus in applying for Chinese National
    Laboratory Accreditation, bringing the total of
    accredited health bureaus to 22.
  • 2. Promoting public knowledge of proper drug use
  • The use of drug labels with 13 required items
    will be promoted and implemented at 15,000
    clinics and 6,000 pharmacies.
  • A pharmacist licensing plan will be promoted.
  • The Drug Identification Handbook (fourth edition,
    covering over 4,200 drugs) will be promoted, and
    5 million CD-ROM copies will be distributed.
  • Classes on proper drug use will be taught to
    community college and sixth-grade students, with
    a 2004 target of 3,000 primary school students
    and 10,000 community college students.

70
Establishing a Unified Food and Drug
Administration System to Protect Public Safety
(2)
  • 3. Strengthening drug abuse management
  • Enhancing the Controlled Drug Abuse Reporting
    Information System
  • It is predicted that in 2004 the number of
    reporting units will grow by 10 to a total of
    106.
  • 4. Implementing Chinese medicine quality control
  • Safe drug use in the field of Chinese medicine
    will be promoted.
  • Chinese medicine producers will be coached in
    good manufacturing practices
  • By the end of February 2005, guidance will be
    provided to at least ten producers of traditional
    Chinese medicine in implementing GMP systems.
  • 5. Strengthening food and drug inspection and
    seizure capabilities.

71
Establishing a Unified Food and Drug
Administration System to Protect Public Safety
(3)
  • 6. Ensuring food safety
  • Guidance will be provided to 70 of fishing
    product in implementing HACCP systems.
  • GM food labeling, monitoring and pre-market
    inspection systems will be implemented, and a GM
    food safety assessment system will be
    established.
  • It is estimated that 235 restaurants will promote
    healthy meals on an ongoing basis, and that 245
    restaurants will obtain preliminary certification
    under the food safety control system.
  • The DOH will continue promoting nutrition
    labeling and national health monitoring systems.

72
Cherishing Life, Investing in Health
  • Drafting a Healthy Taiwan Development Plan
  • Developing a community healthcare service network
  • Developing a national healthcare information
    platform
  • Developing a public health and epidemic disease
    service network
  • Making Taiwans national health information and
    personnel more competitive
  • Promoting the development of the healthcare
    industry and other related industries

73
Legislative Plan for the Current Session
  • 1. Priority bills
  • Department of Health, Executive Yuan
    Organizational Act amendment bill
  • Center for Disease Control, Department of Health,
    Executive Yuan Organizational Statute amendment
    bill
  • Tobacco Hazard Prevention Act amendment bill
  • Pharmaceutical Affairs Act amendment bill
  • Medical Care Act amendment bill
  • Rare Disease Prevention and Orphan Drug Act
    amendment bill
  • Nutritionist Law amendment bill
  • Controlled Drug Management Statute amendment bill
  • Operational Sanitation Management Act draft bill
  • 2. Other related bills
  • AIDS Prevention and Control Statute amendment
    bill
  • Food and Drug Administration Act amendment bill

74
Summary Cherishing Life, Investing in Health
  • Strengthening DOH operations and increasing
    service efficiency
  • Cherishing life, placing value on preventive
    healthcare
  • Freeing people from the fear of disease,
    establishing an infectious
  • disease medical care network
  • Emphasizing whole-person healthcare, enhancing
    care quality
  • Establishing a unified food and drug
    administration system to protect
  • public safety

75
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