Where exactly are my health records? A look into the Taiwanese healthcare system and patients’ rights.

Health records, including medical records as well as medical imaging, contain the first-hand observation and diagnosis of one’s health given by the care provider(s), and are one of the most important health information that an individual owns.

According to Bloomberg (2018), Taiwan ranks No. 9 of the world’s most efficient health care. Therefore, when I first thought about getting health records in Taiwan, I immediately assumed that it will be very effortless. My assumption has a lot to do with my experience living under the country’s National Health Insurance (NHI) system.  

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At a glance: Taiwanese National Health Insurance System

Launched in 1995, the NHI is a single-payer compulsory social insurance plan that centralizes the disbursement of healthcare funds in Taiwan. According to its 2017–18 annual report, the NHI system now covers 99.6% of Taiwan’s residents, and has service contracts with 93% of the country’s hospitals and clinics. Everyone who is covered by the NHI owns a National Health Insurance Card, which contains one’s basic info (full name, national ID number, date of birth etc), NHI info (expiring date of the NHI card, major injuries, fee etc), prescriptions and vaccination records.
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Each time an individual go to a hospital or clinic (for services that are covered by the NHI), all he/she needs to do is providing the NHI card and paying a small amount of fee (usually around NTD 150 per visit) at the reception. When it is his/her turn to speak with the doctor, the doctor will simply insert the person’s NHI card to the card reader and scan through some key information. For instance, the doctor can see information related to previously prescription records and allergies information.

However, I found out that having a NHI card has little to do with ensuring me to have a full records of my health — because medical records & imaging are not stored in the NHI system, but separately in each hospital and clinic. The information being recorded in the NHI card includes: basic personal info (name, date of birth, gender etc), prescription and examination records, treatment records, catastrophic illness record, and organ donation or palliative care registration information.

Hence, far from being able to collect all my health records at once from the NHI system, I actually have to visit each clinic and hospital that I have been to in my whole life to collect my comprehensive set of health records.

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Big hospitals in Taiwan make the application process relatively easy.

According to the Taiwanese Medical Care Law, patients have the legal right to request copies of their medical records as well as medical imaging. The costs of the medical records and medical imaging are clearly defined by law and indicated by each hospitals before you apply — 10 pages of medical records cost around NT$ 150 (around US$ 5), and one medical imaging costs NT$ 200.

For the convenience of patients, most of the big hospitals receive applications via phone, online and in person. As a matter of fact, many of them even have a separate reception that handles these requests —  such as in National Taiwan University Hospital, Taipei Chang Gung Memorial Hospital and Taipei Veterans General Hospital. Therefore, I have to say that the process of getting a copy of my health records from big hospitals is fairly straightforward — Just apply and collect!

  1. Apply: Almost all the big hospitals have clear instructions on their website explaining the application process. In most cases, people can apply for copies of their health records in ways of their choice (e.g. via phone, email, in person). The application form is quite easy to complete — individual just needs to put his/her full name, national ID number, address, phone number and choose the types of data requested. One can also apply for the copies on others behalf.
  2. Collect: After the application has been successfully sent out, it shouldn’t take more than 3 working days before the applicant can collect them. If applying/collecting for other people, the collector must bring letter of authorization and the ID of the applicant upon collection. One drawback is that the collection time is mostly during office hour, so it is a bit difficult for fixed-working-hour officer workers to collect.

In comparison, collecting copies of health records from local clinics seems a bit more troublesome.

Unlike most big hospitals that show the instructions clearly on their website, most of the clinics that I encounter do not have such information available online. Therefore, I have to call them one by one to ask for instructions.

Even though the application process is straightforward, I realized it is impossible to get all of my health records.

Based on the Medical Care Act in Taiwan, “Medical care institutions shall designate appropriate location and appoint personnel for the storage of medical records, which shall be retained for at least seven years.” That is, there is a high chance that the hospitals and clinics that I went to 7 years ago do not store my medical records or imaging anymore. This reality is significantly different from my original assumption, as I thought everything about me is safely stored in certain centralized database, and that I can get it whenever I want.

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After going through the process of getting health records in Taiwan, I have concluded the below two facts.

Fact 1: The Taiwanese NHI system doesn’t store my medical records — each hospital/clinic does. 

What does this mean? 

It will take everyone in the Taiwanese healthcare system a lot of time and money to go to each hospital/clinic to collect the whole picture of his/her health.

Why is this a problem?

It would be easy if someone only has been to one hospital/clinic over his/her life. But in reality, each of us go to multiple hospitals/clinics throughout our lives because of various reasons. In many cases, we change hospitals when we relocate or want to look for specialties. So if you are someone who move around cities (or even countries) often, it will be almost impossible for you to collect all your health records — as the hospital/clinic by law requests you to collect in person (or authorize someone to collect with your ID).

Fact 2: There is by law a 7-year expiration date on our health records!

What does this mean?

The government agrees that medical records dating back more than 7 years can be destroyed — signaling that they are not worth being preserved or at least not worth taking up the storage space.

Why is this a problem?

I believe that all my medical records from the past are still relevant to me (even in a subtle way), and simply because there is no storage space is not a good enough reason to toss such valuable information away.

With chronic diseases becoming the major cause of adult mortality and morbidity worldwide, only 7 years of medical records seem too short for tracking the disease(s) effectively. Moreover, moving towards a future of artificial intelligence and personalized care, the comprehensive set of one’s health information will undoubtably be critical for better predicting and treatments. I personally would not trust a machine to predict my health simply base on health records from past 7 years.

What should we do now?

As someone who values privacy and personal information a lot, I have come up one simple solution: Start collecting your health records NOW — instead of waiting until the moment when you actually need it. I believe that by doing so, we can save future hassle of collecting them in various institutions, ensure the integrity of the health records, and most importantly, become the true owner of our health! 

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