International Health Program, Institute of Public Health, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
DreamWay International Healthcare Centre, Taipei Medical University Hospital, Taipei, Taiwan, ROC.
Health Res Policy Syst. 2024 Aug 14;22(1):106. doi: 10.1186/s12961-024-01180-0.
Since 2006, Taiwan has actively pursued the development of its medical tourism industry. In 2013, the government sought to bolster this sector by integrating medical tourism into the Free Economic Pilot Zones. Despite narrowly missing the mark, the initiative failed to materialize into law. This qualitative study endeavors to discern the pertinent factors influencing the agenda-setting process for incorporating medical tourism into the Free Economic Pilot Zones in Taiwan.
A comprehensive examination of policies concerning the legitimation of medical tourism within the Free Economic Pilot Zones was undertaken through semi-structured interviews and a thorough review of policy documents. Key informants were strategically selected using purposive and snowball sampling techniques. Thematic analysis was applied to scrutinize the amassed data and organize it within the framework of Kingdon's multiple streams.
In the problem stream, increasing financial strains and cost containment pressures under the National Health Insurance program have long driven health care providers to seek further opportunities in medical tourism. The existing barriers to expanding medical tourism in Taiwan included diplomatic tensions (specifically cross-strait relations), public concerns about commercialization of medical care and reduced their access to care, and legal and language barriers. Within the policy stream, factors such as franchise fees to support national health insurance, limited number of demonstration medical tourism sites and services allowed, the allowance of foreign medical personnel, regulations governing domestic physicians, the importance of demonstration, regulation, and accreditation, as well as restrictions on investment from China, were emphasized. The politics stream highlights factors such as governmental support, opposition from opposing parties, public concerns and critics from academia and non-governmental organizations, and skepticism from medical faculties.
Acknowledging the recognized challenges in enacting the medical tourism provision of the Free Economic Pilot Zones Special Act and emphasizing the political will of leadership, a viable policy solution remained elusive. Although a window of opportunity existed for the passage of the bill, it waned as public concerns sidelined the issue from the national agenda. The Taiwan case underscores the necessity for meticulous consideration of issues, proposed solutions, and political dynamics to achieve successful policy enactment.
自 2006 年以来，台湾一直积极发展其医疗旅游产业。2013 年，政府试图通过将医疗旅游纳入自由经济试验区来推动这一领域的发展。尽管该倡议未能达到目标，但未能成为法律。本定性研究旨在探讨影响将医疗旅游纳入台湾自由经济试验区议程设置过程的相关因素。
通过半结构化访谈和对政策文件的全面审查，对自由经济试验区内医疗旅游合法化政策进行了全面审查。使用目的抽样和滚雪球抽样技术战略性地选择了关键信息提供者。应用主题分析来仔细审查收集的数据，并在金登的多重流框架内对其进行组织。
在问题流中，国家健康保险计划下日益增加的财务压力和成本控制压力长期以来一直促使医疗保健提供者寻求更多的医疗旅游机会。台湾扩大医疗旅游的现有障碍包括外交紧张局势（特别是两岸关系）、公众对医疗保健商业化和减少其获得医疗服务机会的担忧，以及法律和语言障碍。在政策流中，强调了一些因素，例如支持国家健康保险的特许经营费、允许的示范医疗旅游地点和服务数量有限、允许外国医务人员、管理国内医生的规定、示范、监管和认证的重要性，以及对来自中国大陆的投资限制。政治流突出了政府支持、反对党反对、学术界和非政府组织的公众关注和批评者以及医学系的怀疑等因素。
认识到实施自由经济试验区特别法中医疗旅游条款所面临的挑战，并强调领导层的政治意愿，仍然难以找到可行的政策解决方案。尽管该法案通过的机会之窗存在，但随着公众关注将该问题从国家议程中边缘化，该机会之窗逐渐消失。台湾案例强调了在实现成功政策实施时需要仔细考虑问题、拟议的解决方案和政治动态。
