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Cablegate: Taiwan: Chiropractors Face Market Access Restrictions

VZCZCXYZ0001
RR RUEHWEB

DE RUEHIN #4051/01 3390302
ZNR UUUUU ZZH
R 050302Z DEC 06
FM AIT TAIPEI
TO RUEHC/SECSTATE WASHDC 3339
INFO RUCPDOC/USDOC WASHDC
RUEHBJ/AMEMBASSY BEIJING 6042
RUEHGP/AMEMBASSY SINGAPORE 6709
RUEHHK/AMCONSUL HONG KONG 7264

UNCLAS AIT TAIPEI 004051

SIPDIS

SIPDIS

STATE PLEASE PASS USTR AND AIT/W
STATE FOR EAP/RSP/TC, EAP/EP
USTR FOR ALTBACH
USDOC FOR 3132/USFCS/OIO/EAP/WZARIT
USDOC for 4431/ITA/MAC/AP/OPB/TAIWAN/JDUTTON

E.O. 12958: N/A
TAGS: ECON ETRD TW
SUBJECT: Taiwan: Chiropractors Face Market Access Restrictions

REF: TAIPEI 3880

1. This is an action request. Please see paragraph 12.

Summary
-------
2. Summary. After years of tolerating U.S.-trained chiropractors
practicing in Taiwan, officials have moved to prevent such
activities. Motivated largely by resistance in Taiwan's medical
community, officials have raided chiropractic offices and indicted
individuals. AIT has raised the issue with Minister of Health HOU
Sheng-Mou, who has agreed to open a dialogue on the issue. End
Summary.

Don't Ask, Don't Tell
---------------------
3. Currently Taiwan has no licensing mechanism for chiropractors.
They cannot advertise (even to post a sign outside their offices)
nor make claims about the efficacy of medical treatment they offer.
This is more than just a theoretical problem. Local health
departments have taken legal action, including raids and
indictments, against several chiropractors. In April of this year
the Department of Health instructed local departments of health that
practitioners of non-invasive body adjustment services, which would
include chiropractors, should be allowed to practice, but the "don't
ask, don't tell" restrictions remain in place. This means that
chiropractors cannot identify themselves as chiropractors, educate
the public about their profession, or differentiate themselves from
therapists.

4. Taiwan, like most countries, does not have any local
institutions that offer chiropractic training. Most of the world's
chiropractors are educated and credentialed in the U.S., where the
field was developed. More than 70 countries, including Singapore,
Thailand, Malaysia, and Hong Kong SAR license chiropractors based on
their U.S. credentials.

Amcham Asks for Action
----------------------
5. In August, Amcham issued a position paper urging Taiwan to halt
administrative proceedings against licensed chiropractors and enter
a dialogue on appropriate methods to permit licensed chiropractors
to perform chiropractic procedures in Taiwan. Amcham forwarded a
copy of this position paper to USTR.

Specifically they want chiropractors to be able to:

--identify themselves publicly as licensed chiropractic doctors,
--advertise their services,
--import and purchase chiropractic equipment,
--prescribe nutritional supplements,
--order X-rays, MRIs, and other appropriate tests and procedures,
--issue sick leave certificates,
--be covered by private health insurance, and
--be regulated by an appropriate semi-government body whose members
are licensed chiropractors.

Working-level DOH Officials Not Encouraging
-------------------------------------------
6. AIT Econoff called on Department of Health Bureau of Medical
Affairs Director Hsueh Jui-yuan, and Section Chief Chou Tao-chun to
raise the issues in the Amcham paper. Dr. Hsueh was not
encouraging, stating it would "take time" to change the situation in
Taiwan. Like the minister, he described chiropractic as relatively
new to Taiwan and that chiropractors should try to work with local
medical schools to offer course work in chiropractic. He stated that
licensing them in Taiwan would be difficult since there was no
chiropractic program of instruction offered here. He stated that
all professions in Taiwan face a constitutional requirement for
coursework, practice, and a Taiwan exam. He suggested that it would
not be possible to license chiropractors here without a locally
administered exam.

LY Bill Probably Going Nowhere
------------------------------
7. On a separate track, there has been some action in the
Legislative Yuan. There is currently a draft bill that would
provide some legal status to chiropractors. It does not offer all
of the protections that they are seeking. Still, local physicians
groups have criticized the bill because they do not recognize
chiropractic as a legitimate medical profession and do not wish them
to be referred to as doctors, but as something akin to "hand
therapists." DOH staff also criticized the legislation. With this
opposition, the bill does not seem to be going anywhere.

Director urges Health Minister to Hold Dialogue
--------------------------------------------- --
8. During a November 14 meeting, AIT Director Young urged Minister
of Health HOU Sheng-Mou to open a dialogue between his Ministry and
U.S.-trained and credentialed chiropractors. Currently
chiropractors have no legal status in Taiwan and must operate
quasi-legally outside the medical system. (Note: The primary focus
of the meeting was the political controversy surrounding the
resumption of U.S. beef imports reported reftel. End note.)

9. Minister HOU replied that none of the medical associations in
Taiwan are in favor of adopting or recognizing US chiropractic
credentials. He also feared the budgetary impact of this pool of
potential practitioners trying to tap into the National Health
Insurance System. The Minister recommended that chiropractors first
try to build support in Taiwan with education programs in Taiwan and
then work to establish their practices here.

10. Director Young replied that AIT viewed this issue as a market
access issue in the context of our overall bilateral economic
relationship. He stated USTR is also concerned about this issue.
Minister HOU then agreed to hold further discussions with the
US-licensed chiropractors in Taiwan to try and find a solution.

11. Action request: Post requests guidance from Washington
agencies on appropriate next steps. In the meantime, we will
continue raising the issue, in the context of market access for U.S.
service providers, at high levels, including with the Minister of
Economic Affairs.

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