Team:TAS Taipei/Policies

POLICY PROPOSALS

Despite Taiwan boasting an affordable and advanced healthcare system for its citizens and having the highest blood donation rates in the world, it still experiences irregular shortages in blood. Therefore, we sought out to explore a myriad of different policy change proposals in Taiwan, whether for private blood collection organizations or governmental regulations, with the goal to further mitigate blood shortages through different reforms.

Blood Donation App

We pitched our proposal for Taiwan Blood Services Foundation (TBSF) to create an official blood donation application (app) by explaining the rationale for why we view there to be a need for this app and presented the mock-up user interfaces (UIs) we created. The purpose of such an app would be to create a centralized, simplified, yet cohesive source of information optimized for mobile devices. We stated that the app would incentivize regular donors to donate consistently and encourage new donors to learn more about the blood donation process and its merits. Additionally, due to its compatibility with mobile devices, the app aims to target a younger, mobile device using demographics who have been statistically shown to donate less. In general, consolidating information related to blood donation in an app format enhances users’ ease of access as users can now obtain pertinent information on the go.

Within the app, blood shortage updates and alert notifications are provided in conjunction with relevant news, stories, testimonials, and reports. To make blood donation appointments, an interactive scheduling calendar paired with live donation site updates in google maps is set up for ease of access and easy booking. A “contact us” feature is also available for direct contact with TBSF when support or enquiries are needed. Additionally, the app provides a shop page to exchange prizes with donation points given after regular blood donations. Mini-games are also available to enhance user knowledge on blood donation practices and statistics. Moreover, infographics, animations, and short videos within the app will be more user-friendly and comprehensible compared to the current TBSF website. Language options are also accessible for user language preferences. Finally, a complete FAQ (frequently asked questions) section offers users information regarding eligibility, scheduling, pre-donation and post-donation guidelines, donation and sanitation processes, and many more. Users can utilize all in-app functions after logging in to their eDonor account, which stores needed user information such as personal health statistics and donation history. However, Mr. Jun-Hong Liu, the director of planning for Taipei Blood Center, cited liability concerns to the app due to fears of personal information being prone to leakage when moving to mobile phone app format, thus TBSF would not be able to bring the app to real life despite its numerous benefits.

Figure 1 - A few of our Blood Donation App mockup user interfaces

Healthcare Spending Policy

We interviewed Legislator Ching-Cheng Chuang (莊敬程), a member of the Social Welfare and Environmental Hygiene Committee of the Legislative Yuan in Taiwan, and his advisor Professor George Chen (陳榮治), who are associate professors of Biomedical Engineering in National Yang Ming Chiao Tung University in Taichung, Taiwan. Being familiar with the Healthcare system here in Taiwan, Legislator Chuang and Professor Chen offered valuable insights to our fiscal policy proposals that are to make the implementation of our project financially viable. As he explained, Taiwan is under a single payer system managed by a governmental agency, with the National Health Insurance (NHI) program awarding a predetermined amount of NHI points - shares of the total annual healthcare expenditure - to hospitals and other organizations for every medical procedure covered by the program. This is known as an ‘Expenditure cap' system, and is used to cap the amount of healthcare spending each year (衛生福利部中央健康保險署, 2005). Each point is now worth around 0.92 NTD (roughly 3.2 US cents)(Chen, 2020).

As it currently stands, NHI awards 575 points to blood banks for every whole blood bag processed (Chen, 2017). Thus, we proposed raising the amount of points (upwards to 900 points) awarded to cover any additional costs for the implementation of our blood antigen cleavage system, such as column costs, enzyme costs, and extra costs in labor and handling of the blood product. Yet, throughout the years TBSF (the only blood bank organization in Taiwan) has consistently earned a net asset (having higher revenues from existing NHI funding than expenditures in organizing blood donations), building up a considerable cash reserve (Taiwan Blood Services Foundation, 2019). Because the point system constitutes shares of a limited pie, healthcare funding is a zero sum game; unnecessary increases of point award in the handling of donated blood would take away valuable funding in other sectors of healthcare (such as eldercare and emergency medicine). Therefore, Legislator Chuang suggests that TBSF should be financially responsible for increased costs in blood antigen cleavage, as they could most likely afford so without increases in governmental assistance.

Relaxation of Blood Donor Restrictions

We interviewed Dr. Wen-Chien Chou, an experienced Hematologist at the National Taiwan University Hospital and the current Chairman of The Hematology Society of Taiwan. Dr. Chou notes that to increase the amount of donations, adjustments in eligibility policy to increase the donor pool. Currently, Taiwan has strict rules in regards to who can donate and who cannot. In particular, those who are above age 70 (with considerable restrictions after age 65) and/or those who have high blood pressure are strictly prohibited from donating, even though many are perfectly healthy and other eligible. He argues that certain restrictions such as these could be loosened. However, he does note that blood banks put the wellbeing of donors and blood recipients first, and they are often wary of the risks that come with loosening restrictions. Any modifications to current regulations thus need to be mild to prevent any unintended negative health consequences for the donor or patient, as this would be worse than having a shortage in blood.

iGEMers Blood Donation Trips

Over the past months, several members of our team went and donated their blood, as Taiwanese law allows for those aged 17 and above to donate blood without parental consent. Below is a recount of their experiences.

Alan L. went to donate blood two times - first time in a blood donation center, and second time in a bloodmobile. Laura H. donated blood one time in a bloodmobile. Both Laura and Alan had a similar procedural experience, although the blood donation center was noticeably more spacious. After entering the blood donation site, they were asked to input personal information, medical history, and contact details on a tablet. Then, blood pressure was measured, and they reported their weights.

For Laura, another staff member asked her what she had consumed throughout the day prior to arriving at the blood donation site, and the staff member deemed the amount of food she consumed as insufficient, directing her to eat the biscuits and juice they provide outside of the blood mobile.

Next, they were directed into a small room for a brief interview, covering current medical status, sexual activity, and general physical condition on the day. A big emphasis was placed on HIV/AIDS and sexual history to prevent any adverse outcomes through blood transfusion. Both donors signed forms confirming all reported information was correct. Donors had their forefingers pricked to test blood Hemoglobin levels.

In preparation for the blood donation process, blood donation site personnel cleaned the inner elbow region of the arm with a more viable blood vessel. Donors sit on an inclined sofa-chair and a nurse begins drawing blood. As first time donors, Laura and Alan could only donate 250 mL (one unit) of blood, but in his second time, Alan was able to donate 500 mL (two units of blood). After completing the blood drawing process, donors rested on site for approximately 10 more minutes for observation and were given complimentary snacks and beverages to consume. The whole process took roughly 45 minutes from start to finish.

From Laura and Alan’s donation trips, we learned that TBSF’s operations are very methodical and efficient. As such, we conclude that TBSF’s blood processing center likely operates in a similar fashion to their blood donation sites, underscoring the importance for our project to integrate seamlessly into existing standardized processing frameworks such that our solution does not pose as a greater hindrance than help. Moreover, we understood that the blood donation process is straightforward and optimized for donors’ comfort/safety. Knowing this, we felt more legitimized promoting blood donation to members of our community. Our promotion efforts for blood donation has been through our social media pages, roundtable discussion, and blood donation app proposal.

Figure 2 - Laura’s Blood Donation Trip in Bloodmobile

Figure 3 - Alan’s Blood Donation Trip in Bloodmobile - Image of Interview Room at Blood Donation Center

References

Chen, Emily Hui-Chen. “請不要再說捐血沒有成本，也不要再說我們是賣血的.” The News Lens 關鍵評論網, 14 Jan. 2017, https://www.thenewslens.com/article/59342.

Taiwan Blood Services Foundation. “TBSF 2019 Annual Report.” Taiwan Blood Services Foundation, 2019, http://intra.blood.org.tw/upload/6657d89b-a4e0-4311-a704-ec2fd0a4ff61.pdf.

衛生福利部中央健康保險署 . “總額支付制度意涵.” 衛生福利部中央健康保險署, 2005, https://www.nhi.gov.tw/Resource/webdata/32213_3_hosp_global_stable_eva_106y_1060112_ICD.ods

陳 亮甫. “健保給付「1點1元」，如何拯救台灣醫療？: 陳亮甫.” 鳴人堂, 鳴人堂 | 聯合新聞網, 9 Mar. 2020, https://opinion.udn.com/opinion/story/120803/4388788.