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Cablegate: Health Minister Says Taiwan Working to Prepare

This record is a partial extract of the original cable. The full text of the original cable is not available.

292231Z Aug 05







E.O. 12958: N/A

REF: A) 2005 STATE 15149 B) 2005 TAIPEI 00058 C) 2004 TAIPEI
0249 D) 2003 TAIPEI 03339 E) 2004 TAIPEI 00479 F) TAIPEI
2626 G) TAIPEI 2731

1. Summary. In accordance with reftel A, AIT Director Paal
delivered Undersecretary Dobriansky's avian influenza (AI)
demarche to Taiwan Department of Health (DOH) Minister Hou
Sheng-Mou on August 26. Paal thanked Taiwan for making AI a
high priority and encouraged Taiwan to take even more
preparatory efforts than it already has. Paal also took the
opportunity to raise World Health Organization (WHO)
collaboration and pharmaceutical issues. Regarding WHO, Hou
said Taiwan will employ a strategy of "meaningful
participation" by which it will try to attend and provide
valuable input to as many WHO meetings as possible. On
pharmaceutical issues, Paal urged Taiwan to revise policies
under which health care providers are encouraged to squeeze
pharmaceutical companies for cost savings. Hou promised DOH
was doing all it could to find funds to support innovative
pharmaceuticals and suggested regularizing a U.S./Taiwan
dialogue on medical devices and other health issues. End

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Avian Influenza

2. Paal delivered Undersecretary Dobriansky's AI demarche to
Taiwan DOH Minister Hou Sheng-Mou on August 26. The points
were modified slightly to recognize the high priority the
Taiwan Government is already placing on the issue. Paal
further acknowledged the significant efforts underway to
address the potential of a flu pandemic-- including
President Chen Shui-bian's recent National Security Council
meeting on the issue (see reftels B-E for plans up to early
2005; septel will provide details on more recent efforts).
Paal also welcomed Taiwan's continued excellent
collaboration with the United States Centers for Disease
Control (USCDC) built upon the very close cooperation
established during the SARS crisis.

3. Hou responded by once again expressing Taiwan's deep
appreciation of the help provided by the U.S. during the
SARS crisis. Hou commended the continued close
collaboration between Taiwan CDC and USCDC that has
continued following the abatement of SARS. Hou also
referred to his recent meeting with US Department of Health
and Human Services Secretary Michael Leavitt. He noted
that, at that meeting, it was agreed that the two sides
would regularize bilateral health cooperation meetings. Hou
hopes that the next bilateral meeting will be held before
the end of 2005 in either Washington DC or Atlanta.

4. Hou said that AI would be one of the major topics of
discussion (others would include medical devices and a
discussion of all of the successes resulting from using a
smart card for Taiwan's national health insurance program).
Hou related how he had promised Leavitt that Taiwan would
serve as the "USCDC's sentinel guard" for AI in Taiwan. Hou
also reported how following President Chen's emphasis on
making AI a priority issue, Hou has spent most of his time
doing risk communication on AI to executive branch agencies,
the legislature, mayors and commissioners.

5. Paal encouraged Taiwan to continue to work even harder
to get the message out as several high-level government
contacts recently told him that they had not drawn up any AI
contingency plans for their ministries. Paal informed Hou
how AIT has drawn up extensive AI contingency plans,
including personnel evacuation plans and provisions for home
isolation in the event evacuation from Taiwan would not be
possible following an AI outbreak. Paal strongly encouraged
Taiwan to require that all government institutions do the
same type of contingency planning. Paal also urged that
Taiwan encourage all of its citizens to have contingency
plans and provisions in the event they are isolated in their
homes. Hou agreed that, while Taiwan has done emergency
drills at hospitals and included AI in a recent disaster
planning exercise in Taichung, more such contingency
planning is needed.

6. Hou noted a suggestion by Paal that Taiwan move its
poultry operations indoors in an effort to prevent infection
crossing over from wild to domestic bird stocks. Hou also
responded favorably to Paal's suggestion that Taiwan provide
briefings to international missions on AI and encourage
foreign missions to also prepare. Finally, Paal recommended
that Hou try to arrange an interview on the subject on
Taiwan's largest English-speaking radio station in order to
try to educate the foreign community in Taiwan about the
importance of AI contingency planning, and the efforts that
Taiwan is taking to counter a potential pandemic.


7. Paal took the opportunity to raise World Health
Organization (WHO) collaboration. Hou said that an
interagency meeting had recently concluded that with regard
to WHO, Taiwan will employ a strategy of "meaningful
participation" by which it will try to attend and provide
valuable input to as many WHO meetings as possible. He
noted that thus far, Taiwan has been able to participate in
four WHO meetings (two on traditional medicine in china, one
on health promotion in Thailand and one on health promotion
in Switzerland).

Pharmaceutical Issues

8. Turning to pharmaceutical issues, Paal noted U.S.
concerns that proposed revisions to Taiwan's National Health
Insurance Law would eliminate statutory requirements that
hospitals and medical practitioners be reimbursed for
medicine and equipment at actual transaction prices (ATP).
Although this provision is currently not enforced, U.S.
producers believe the proposed legalization of the current
reference pricing system will increase the pace of mandatory
price cuts by the Bureau of National Health Insurance (BNHI)
and encourage Taiwan medical providers to continue demanding
deep discounts for pharmaceuticals and medical equipment.

9. Hou responded that the proposed amendment of the NHI Law
is part of DOH's plan for "second generation" NHI reform.
BNHI is chronically short of funds and has instituted a
"global budget" system that caps NHI payments to medical
providers. Limiting expenditures through reference pricing
may be one way for the cash-short bureau to increase the
amount of money available to pay for new drugs, he said.
Bureau of Pharmaceutical Affairs (BOPA) Director General
Liao Chi-chou noted that the International Research
Pharmaceutical Manufacturers Association (IRPMA) had
recommended that BNHI enact rules that would allow patients
to pay out-of-pocket the difference between the
reimbursement price and the actual cost for some medicines
as a means of reducing BNHI's costs. Hou added that
revisions in the regulations to base premiums on household
income vs. wages would increase the amount of funding
available for new drugs.

10. Liao then raised DOH's hope that the U.S. would be
willing to consider a regular meeting to discuss medical
device related issues. He said that the U.S. and Taiwan had
signed an Exchange of Letters in 1998 on medical devices and
suggested that a regular meeting could take place under the
framework created by the letters. Hou noted his hope that
the next health bilateral would include discussions on Avian
Influenza, medical device issues and NHI reforms. Taiwan
has many valuable experiences, including the use of
"SmartCard" technology, which it would be willing to share
with U.S. counterparts. Hou acknowledged that medical
device registration and licensing had not proceeded as
smoothly as DOH had hoped as the initial deadline passed in
June (reftels F and G), but he insisted that he would
personally monitor the situation and assign all necessary
personnel to ensure registration and licensing approvals
were issued prior to the new December 2005 deadline.

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