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The planning process has given us enormous opportunity not only to plan an integrated care/research/education system for the 21st century, but also to consider who we are, what we are doing now, what we want to become, how we can change to fit our vision of future needs, and how we will get there.

Renovation of West-Side Campus

The graceful Renaissance architecture of the current West-Side building dates to 1912. Today, the nearly century-old West-Side campus remains the main site for outpatient services. With more than 6,000 outpatient visits per day, so the West-Side campus can no longer provide the desired optimal patient care and services. Our immediate priority therefore is the planning and renovation of the West-Side campus, which will include a Children' Health Center, cancer Center, Neuroscience Center, as well as a world-class medical and surgical Ambulatory Center. We must plan a medical campus flexible enough to embrace changes and advances that we may not now foresee. We thus approach this goal by pursuing knowledge, concerning future development and then applying that knowledge to collaborative efforts in our research, education, and patient services.

The Virtual Hospital

New technological capacities have dramatically improved the environment for patients, increasing their comfort and their access to information. Current inpatient and outpatient services soon will no longer meet the patients' needs. We will have to improve the entire hospital information system for real-time access of long-term diagnostic and treatment data, handling of electronic medical records, appropriate and speedy support for decision making, and improvement in outpatient services and in-patient communication system. Patients would then be able to gain instant access to information about their care, including test results and pathways that will help them adjust their expectations for each day that they are hospitalized. We should also plan to have advanced communication systems that allow multi-site consultation. We will thus create a health information network to link physicians, hospitals, and affiliated health care providers with our academic medical center.

A New Environment of Healing

For the past 30 years, the NTUH made enormous efforts in assisting more than 30 affiliated community care establishments, ranging from local government hospitals to private hospitals and clinics. There is becoming increasingly necessary for us to build a new hospital or medical center at a distance from the main campus in Taipei. Requests come from county governments to help them to meet the urgent need for the highest quality of medical care for which the local residents call. Although much of the new medical center proposed for Hsin-chu and the new Children' Health Center (CHC) on the West-Side campus are still in the master planning stage, there is the general consensus that our new facilities should be designed in such a way that we could move patients easily and efficiently between the inpatient and outpatient units. This would enable the staff to participate in large-scale clinical trials, and to expedite results that would save lives. We remain dedicated to training the next generation of clinical investigators in this important and unique discipline.

This planning process has given us an enormous opportunities, not only for planning an integrated care/research/education system for the 21st century, but for considering who we are, what we are doing now, what we want to become, how we can change to fit our vision of future needs, and how we will get there. We have the opportunity to create the finest academic health center in Asia and to shape the future as we move into the new century.

Clinical Research

The 21st century will be the age of translational medicine. Researchers and physicians will be expected to move basic research findings expeditiously from the bench to the bedside. They will also be increasingly challenged to align the personnel, support services and resources that enable study in the laboratory. The Office for Clinical Research (OCR) facilitates research that involves patients and benefits them as well. The studies under way at the NTUH address every field from hepatitis, atherosclerosis, and diabetes, to cancer, metabolic disease, and psychiatric disease, to name just a few.

The OCR seeks to provide support for research scientists, postdoctoral fellows, research nurses, statistics/bio-information support, computer expertise, and laboratory space required for studies in both inpatient and outpatient settings. Additional shared resources will be created.

Educational Reforms

We are committed to providing a safe environment for the teaching and learning of clinical and communication skills. Our aim is to enable students to develop and maintain competence in all aspects of medicine, nursing, and pharmacy in a variety of health care settings. We seek to develop and evaluate new teaching and assessment strategies to promote independent learning and foster new initiatives in clinical education. We will integrate the use of problem-based learning and electronic learning resources (i.e., computer-based clinical simulations) into the teaching and assessment of clinical skills.

Biotechnology

The biotechnology revolution that has transformed and continues to change the landscape of health care, beginning at the benches of university scientists. The development of biotechnology will have a great influence on the diagnosis and treatment of diseases. It will also make a significant impact on the improvement of the economy in Taiwan, surrounding regions, and beyond. The proposed Bio-Medical Research Center (BMRC) will bring together investigators with complementary expertise and technical skills. A broad-based graduate-training program will provide students and young investigators with a wider perspective on their respective research areas. The program not only will enable trainees to utilize their training in academic science, but also will open other possibilities in their career development, including medicine, industry and other biotechnological applications. The main function of the BMRC should be to serve as a bridge between clinical and basic research.

Health Policy

Implementation of National Health Insurance (NHI) in 1995 represented the realization of a primary social and health policy goal of the country. The ultimate goal of the program is universal coverage for all of Taiwan citizens. It is estimated that NHI currently covers more than 96 percent of the population. In 1995, national health care expenditures in Taiwan totaled US$13.12 billion, representing 5.23% of the GDP. By 1998, these expenditures amounted to approximately 6% of the GDP.

With the rapid growth of health insurance expenditures and a slow increase in premium collection, the NHI Bureau has had to take action to maintain a balance of income and expenditures to reduce deficits and to be financial self-sustenance. Some actions being proposed are as follows: 1) To adjust the proportion of the monthly premium to the salary of the beneficiaries. Right now, the premium is collected at only 4.25% of the reported salary of the beneficiaries. 2) To increase cost-sharing; the patient shares only 8-9% of the ambulatory care expenses and 5-6% of the hospitalization expenses; this is not enough to prevent the patients from over-using medical services. 3) To expand the case-payment system. 4) To introduce managed care under a global budget. And 5) to provide consumers choices of insurance plans.

The NTUMC will always play a leadership role in educating the public about health, in fostering informed health policy, and in bringing real value to the health care system. Also, to reflect the changing health care system, we will move from being only an acute-care hospital to a system that delivers a full range of medical services covering a patient entire lifetime. The Medical Center will combine many vital components, including some not usually considered part of an academic medical center, such as primary-care and preventive health services.