Why Are Taiwanese People Reluctant to Seek Medical Treatment in Mainland China? The Harsh Truth Behind This is Quite Unsettling!

Why are Taiwanese people reluctant to seek medical treatment in mainland China? The harsh truth behind this is quite unsettling! (Video)

[People News] Hello, dear viewers, and welcome to "Forbidden News Decoded." I am Sun Ning.

Every day in mainland China, tens of thousands of Taiwanese individuals navigate through Lujiazui in Shanghai, the Technology Park in Shenzhen, or the factories in Kunshan. They engage in business, work, study, start families, and even purchase homes to settle down. To outsiders, it appears that they have seamlessly integrated into the life of this region.

However, within this community, there exists an unspoken and somewhat harsh "rule"—that is: "For minor ailments, just tough it out; for serious conditions, buy a plane ticket; it’s preferable to wait for a hospital bed in Taiwan than to be admitted to a ward in mainland China."

This is not merely a cold slogan, but rather a "survival guide" forged through the blood, tears, and financial sacrifices of countless Taiwanese entrepreneurs and professionals. Many Taiwanese business owners with assets exceeding ten million in mainland China, when confronted with a surgery that may require significant intervention, do not instinctively think of booking an appointment at one of China’s top hospitals. Instead, they would rather endure excruciating physical pain and book a flight back to Taiwan overnight.

Why is this the case? Is it because the medical facilities in mainland China are not advanced enough? Or is it that the skills of doctors in mainland China are not sufficiently high-level?

The situation is clearly more complex than it appears. Behind this 'life and death ticket' lies a fundamentally different set of values between the two sides of the Taiwan Strait regarding social systems, economic safety nets, healthcare systems, and even the concept of 'human rights and dignity.' In today's video, we will delve into the realities of cross-strait healthcare, using authentic data and clinical insights to analyze why Taiwanese individuals in mainland China are reluctant to seek medical treatment there when they become ill.

The 'downgrading strike' of medical insurance reimbursement

When discussing healthcare, the first issue that invariably arises is the question of 'money.' Many Taiwanese living in mainland China have complied with regulations to enroll in the mainland's 'Employee Medical Insurance' or 'Resident Medical Insurance' and possess the blue social security card. However, it is only when they confront a serious illness that they realize the medical insurance in mainland China and Taiwan's National Health Insurance are not comparable.

In mainland China, if you are merely suffering from a cold, fever, or diarrhea, or if you visit a community health clinic for some domestic medications to lower blood pressure, the mainland's medical insurance can indeed reimburse part of your expenses. However, when a person falls ill, can they only experience minor ailments? Once faced with serious conditions such as cancer, leukemia, severe cardiovascular diseases, or other chronic illnesses, this fragile medical insurance safety net can be quickly overwhelmed by exorbitant medical bills.

In mainland China, there exists a 'systemic trap' that causes immense despair and heartache for the general public, referred to as the 'medical insurance catalog.' When patients face serious illnesses, doctors typically recommend more effective imported original research drugs, new targeted cancer therapies with fewer side effects, or high-quality imported materials for surgeries. Unfortunately, the vast majority of these life-saving medications and materials are not included in the medical insurance catalog and are classified as 'fully self-funded items.'

For example, consider a real case: a Taiwanese expatriate in mainland China was diagnosed with lung cancer, and the total cost for the entire treatment amounted to 500,000 yuan. When the family attempted to settle the bill using their medical insurance card, they were informed that only 150,000 yuan of the total was considered 'policy-compliant expenses,' while the remaining 350,000 yuan for imported targeted drugs and special materials would need to be paid out of pocket. Additionally, the 150,000 yuan of compliant expenses would only be reimbursed at a rate of 60%, meaning the insurance would ultimately cover just 90,000 yuan.

Thus, the total expenditure reached 500,000 yuan, with the medical insurance reimbursing 90,000 yuan, leaving the patient responsible for 410,000 yuan! The actual reimbursement rate is less than 20%! Such a bill represents a catastrophic burden for an ordinary middle-class family.

However, if this Taiwanese individual opted to seek treatment in Taiwan, the experience would be entirely different.

Taiwan's National Health Insurance operates under a 'single-payer' system, which is characterized by 'no deductible and minimal boundaries between policy and non-policy.' In Taiwan, regardless of the severity of your illness, as long as you enter a contracted hospital under the health insurance system, you will only need to pay a fixed and very minimal outpatient registration fee and a 'co-payment.' The vast majority of routine treatments, surgeries, and hospitalization costs are fully or largely covered by the health insurance pool.

Additionally, Taiwan has implemented a 'Major Illness Card' system for serious diseases. Once a patient is diagnosed with cancer, a rare disease, long-term dialysis, or a major mental illness, they can receive a Major Illness Card. This card ensures that all 'personal co-payments' related to outpatient and inpatient treatments for that illness, which are covered by health insurance, will be completely waived!

For instance, a cancer patient admitted to National Taiwan University Hospital for a complex Da Vinci minimally invasive surgery, using the latest international treatment drugs, may find that the bill presented to their family upon discharge is only a few thousand to tens of thousands of New Taiwan Dollars. In contrast, in mainland China, this could amount to the down payment for a house.

In comparison, seeking medical treatment in mainland China can be a stressful experience filled with calculations of out-of-pocket expenses. However, returning to Taiwan for treatment means that health insurance provides comprehensive life support. This is the real reason why Taiwanese individuals in mainland China, when faced with even slightly serious illnesses, will endure severe pain and even use wheelchairs to desperately return to Taiwan—because in the face of Taiwan's health insurance, the flawed medical insurance bills in mainland China can truly push an ordinary family to the brink!

The 'homogeneity' and 'mismatch' of medical standards.

Upon reading this, some viewers might argue: serious illnesses are expensive everywhere. If I go to the top hospitals in mainland China and spend a bit more, isn't the medical quality just as high? There are many world-class experts in mainland China now!

Indeed, when it comes to the 'pinnacle' of medical technology, the leading experts at top hospitals in first-tier cities like Peking Union Medical College Hospital, Ruijin Hospital in Shanghai, and West China Hospital in Sichuan have surgical skills and facilities that are comparable to those in Taiwan.

However, this highlights the harsh reality of healthcare in mainland China—extreme polarization and severe misallocation of resources.

The medical landscape in mainland China is marked by an insurmountable divide between urban and rural areas, as well as regional disparities. While the large hospitals in Beijing and Shanghai are world-class 'paradises,' stepping outside these first-tier cities into county towns or rural hospitals reveals a shocking decline in medical quality, diagnostic capabilities of doctors, and availability of medications.

This severe misallocation of resources means that among China's 1.4 billion people, once someone becomes seriously ill, their only option is to desperately rush to these top-tier hospitals in Beijing and Shanghai.

This situation has also led to the emergence of a tragic group unique to China, referred to as 'medical refugees.'

In mainland China, do you want to receive treatment for a serious illness? Unfortunately, you first have to navigate the 'black market ticket' barrier. At top-tier hospitals, the appointment slots of renowned experts can be marked up by 'scalpers' to several thousand yuan, which is quite common; it is no longer surprising for patients' families to sleep on the floor in hospital corridors or in nearby basements for months just to secure a hospital bed.

In contrast, Taiwan has maintained its position as the top-ranked country in the world for several consecutive years in the "Global Healthcare Index" from the internationally recognized statistical database Numbeo [nʌmˈbiːoʊ]. This prestigious title is not attributed to any extraordinary technological advancements in Taiwan, but rather to four key words: high homogeneity.

Despite its small land area, Taiwan boasts an impressive density of medical resources and a high level of standardization in quality. Whether at National Taiwan University Hospital in Taipei, China Medical University Hospital in Taichung, Chang Gung Memorial Hospital in Kaohsiung, or Tzu Chi Hospital in Hualien, there is virtually no significant difference in the training backgrounds of physicians, treatment protocols, drug quality, and advanced medical equipment.

Patients receiving cancer treatment in Taipei will receive the same standardized treatment plan as those in Tainan. Consequently, the people of Taiwan do not need to sell their possessions and travel with their families to become "medical refugees" just to access treatment for common serious illnesses.

Furthermore, Taiwan's healthcare system places a strong emphasis on "people-centered" humanistic care. In mainland China, the sheer volume of patients often turns doctors into assembly line workers, with each patient receiving only 3 to 5 minutes of consultation time. Doctors quickly type on their computers, issue numerous test orders, and send patients on their way, often leaving them confused about their diagnosis and the reasons for their prescribed medications.

In Taiwan, doctors take the time to patiently and thoroughly explain patients' conditions, utilizing models or charts to illustrate how surgeries are performed, the associated risks, and available alternatives. This respect for patients as 'individuals' and the reassurance provided by the high transparency of information is something that the 'fast-food style medical care' in mainland China can never offer.

The 'Trust Barrier' in Doctor-Patient Relationships

While the differences in costs and technology are tangible, the significant contrast in doctor-patient relationships across the strait represents a deeper spiritual and psychological impact.

For Taiwanese individuals living in mainland China, a profound fear of seeking medical care there when unwell arises from the stifling atmosphere of 'distrust' prevalent in mainland hospitals. For an extended period, the doctor-patient relationship in mainland China has been characterized by a near 'armed confrontation' state, with incidents of 'violence against doctors' and 'medical disputes' leaving indelible scars on the system.

We must not forget the heartbreaking real-life cases: Dr. Yang Wen from Beijing Civil Aviation General Hospital, who tragically lost his life due to a violent attack by family members over a medical dispute in the duty room; and Dr. Tao Yong, a leading ophthalmologist at Chaoyang Hospital, who was violently assaulted by a patient he had personally treated and helped regain partial vision, nearly jeopardizing his medical career.

The tragedies we see stem from the "complete breakdown of mutual trust" resulting from the long-term distortion of interests within the mainland's medical system. Public hospitals in the mainland have been operating under a self-financing model for a long time, which has led to the emergence of a distorted chain of interests. When patients enter hospitals and are confronted with exorbitant bills and unnecessary repeat tests, they instinctively question: "Is this doctor trying to pocket a kickback or inflate their performance metrics by overcharging me?" 

When treatment outcomes fall short of expectations, or when a patient sadly passes away, this accumulated distrust can trigger a "chain reaction" of outrage. In a context where legal recourse is slow and local protectionism is rampant, a mafia-like "medical disturbance" industry has emerged—families set up mourning altars at hospital entrances, display banners, and even assault medical personnel to pressure hospitals into private settlements for compensation. 

In recent years, the Chinese Communist Party has taken strong measures, incorporating "medical disturbances" into criminal law and deploying armed police at major hospitals while implementing strict security checks. Doctors even joke about needing to "wear helmets to work." However, this enforced calm, driven by state power, has not fostered trust; rather, it has created a cold "defensive medical wall."

Currently, doctors in mainland China tend to practice defensive medicine as a means of self-protection. To avoid lawsuits or backlash, conditions that could previously be diagnosed based on experience now require patients to undergo CT scans, MRIs, and blood tests, creating irrefutable 'objective evidence.' In cases involving critically ill patients with extremely low survival rates and high risks, many hospitals and doctors, in an effort to prevent disputes from arising if a patient dies on the operating table, will often tacitly suggest that patients 'transfer to another hospital.'

In stark contrast, the doctor-patient relationship in Taiwan is characterized by a completely different dynamic. In Taiwan, physicians enjoy a high social status and are widely regarded as societal elites and lifesavers. The relationship between doctors and patients is one of 'partnership based on trust and the rule of law.'

Why do patients in Taiwan not feel the need to guard against doctors as if they were thieves?

This situation is closely tied to Taiwan's health insurance system. The health insurance in Taiwan enforces strict total expenditure caps and cloud-based reimbursements, meaning that doctors cannot receive substantial kickbacks for prescribing more medications or conducting additional tests; rather, they risk severe penalties from the health insurance authority for being classified as engaging in 'malicious deductions.' Patients are well aware that every test and medication prescribed by doctors is subsidized by the health insurance, eliminating any direct 'conflict of interest' between the two parties, thereby reinforcing the foundation of trust.

Simultaneously, Taiwan officially enacted the "Medical Accident Prevention and Dispute Resolution Act," known as the Medical Prevention Act, starting January 1, 2024. This legislation mandates that when a medical dispute arises, it must first go through "mandatory mediation" facilitated by the local health bureau before any legal action can be taken. Neutral medical and legal experts will intervene to provide professional risk assessments and psychological support. Individuals with grievances can seek resolution through legal avenues, while those facing unfortunate situations can access social assistance.

In Taiwan, it is uncommon to witness family members of patients causing disturbances in hospitals, as the system offers them a platform to express their concerns. Doctors, in turn, can focus entirely on their life-saving work without the burden of worrying about potential issues with the current patient while performing surgery. This compassionate and secure environment makes it difficult for Taiwanese individuals, who experience the cold medical atmosphere on the mainland, not to long for their hometown.

The "Collective Withdrawal from Insurance Tide" Post-Pandemic

If the issues of costs, resources, and doctor-patient relationships discussed earlier highlight the long-standing structural divide in the medical systems across the strait, then the financial challenges faced by mainland China in the wake of the pandemic resemble an unexpected and chilling tsunami, completely eroding the last vestiges of medical security for ordinary citizens with overwhelming force.

In the aftermath of the pandemic, mainland China is grappling with the dual challenges of local fiscal tightening and an economic downturn. The extensive expenditures on epidemic prevention over the past three years have significantly drained the medical insurance fund reserves across various provinces and cities. To avert a complete depletion of these funds, the Chinese Communist Party (CCP) has introduced a highly controversial 'medical insurance reform' in recent years, which has drastically cut the amounts allocated to individual accounts. As a result, the funds available for the public to purchase medications at pharmacies have been severely reduced, leading to widespread protests among retired elderly citizens in cities like Wuhan, a movement that has been dubbed the 'White Hair Movement'.

To further manage costs, the CCP's medical insurance bureau is employing two stringent measures: 'centralized drug procurement' and 'package payment by disease type'.

The 'centralized drug procurement' strategy aggressively negotiates prices, effectively removing effective foreign-imported 'original research drugs' with minimal side effects from the list, replacing them with low-cost domestic generic drugs whose efficacy is often questioned.

On the other hand, the 'package payment by disease type' policy establishes a cost ceiling for each illness. If a doctor prescribes an effective imported drug that exceeds this limit, the additional costs are deducted directly from the doctor's salary and bonuses.

Faced with such high-pressure policies, hospitals are taking drastic measures to protect themselves by 'shelving and cutting off supply' of imported original research drugs in their computer systems. This forces doctors to 'downgrade prescriptions' and even compels patients' families to purchase medications out of pocket from external pharmacies, effectively shifting the financial burden of medical gaps onto the general public.

The situation of 'health insurance becoming increasingly difficult to access while premiums continue to rise year after year' has even sparked a rare trend of 'urban and rural residents withdrawing from health insurance' in the grassroots rural areas of mainland China. Local farmers have started to perceive this health insurance as a burden. For Taiwanese individuals who are used to high-quality welfare healthcare, this environment induces significant anxiety and resistance. Consequently, seeking medical treatment in Taiwan has become their only and final lifeline.

Universal Coverage vs. Special Provision for High Officials

The healthcare system serves as a mirror, reflecting a society's genuine attitude towards life.

The starkly different outcomes of the healthcare systems on both sides of the Taiwan Strait stem from the fundamentally different target audiences and starting points in their initial designs.

Taiwan's National Health Insurance (NHI) is fundamentally based on the principle of 'social mutual assistance and human rights protection for all.'

In Taiwan, whether you are a billionaire tech mogul or a low-income individual receiving welfare, the premiums you pay each month may differ significantly based on income, but if you fall ill and enter the same hospital, you will be treated in the same NHI ward, receive the same NHI medications, and enjoy the same dignified medical services.

In Taiwan, no high-ranking official can legally and forcibly monopolize the health insurance resources that belong to all the people of Taiwan due to their power. Taiwan's health insurance system treats every ordinary citizen as a valuable 'human' deserving of protection.

In contrast, the core logic of the health insurance system in mainland China prioritizes providing unlimited life support for high-ranking officials.

In the public healthcare system on the mainland, there exists a taboo area that the general public is acutely aware of but cannot approach—the 'High-ranking Officials Medical Special Protection System.' Every large public tertiary hospital in China has strictly guarded 'Cadre Health Care Wards' or 'South Building.' 

An accidental leak of internal government data once shocked society: it revealed that up to 80% of the medical expenses funded by the Chinese Communist Party government are prioritized for a privileged group of 8.5 million party and government officials. Nationwide, around 400,000 officials have long occupied these cadre wards, with annual expenditures for this alone reaching 50 billion yuan. 

In China, officials at the ministerial and vice-ministerial levels enjoy medical insurance benefits that are '100% reimbursed by the government.' They do not have to worry about procuring generic drugs or budgeting their expenses. Even high-ranking officials suffering from multiple organ failure or in a vegetative state can be forcibly 'kept alive' for years on life support systems costing tens of thousands of yuan per day. As long as they have a breath left, their families can continue to enjoy the associated political privileges and substantial pensions. 

This is the crux of the issue. Why do Taiwanese people living on the mainland insist on returning to Taiwan when they fall ill? Because they understand very well that if they stay on the mainland, as an 'ordinary person' without privileges, they can only survive or perish in the fragile and diminishing pool of medical insurance.

When you return to Taiwan, that small green health insurance card serves as the soul shield promised to every citizen by their hometown. It conveys the message that regardless of how long you have been away or whether you are rich or poor, if you are injured or fall ill, this system will support you unreservedly, providing the utmost dignity and the highest quality of care.

That concludes today’s content. If you enjoyed our program, please give us a thumbs up, subscribe, and activate the notification bell. We also welcome your thoughts on the disparities in health insurance levels between Taiwan and the mainland in the comments section. We look forward to seeing you in the next episode!
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