【Column Article】Liberty Republic “Lee Po-Chang’s Column | The Integration of Clinical Medicine and Public Health is the Key to Healthcare Reform”

Lee Po-Chang / Distinguished Chair Professor, College of Public Health, Taipei Medical University

Recently, I had the great honor of being invited to share my life journey with graduates at the commencement ceremony of the College of Public Health at Taipei Medical University. In 1979, after graduating from Taipei Medical College, I entered clinical practice and later served as Director of Surgery at National Cheng Kung University Hospital, Superintendent of Tainan Hospital, Ministry of Health and Welfare, and Director-General of the National Health Insurance Administration (NHIA).

When I first joined NHIA, I deeply understood that the medical community in Taiwan despised the NHIA — the term “cheap insurance” (賤保) perfectly described their sentiment! I knew clearly that health insurance was the most crucial part of healthcare reform. My conviction as Director-General was to improve the overall healthcare environment so that medical professionals could have a happy and supportive workplace, ultimately providing the best quality care to our people.

As a clinical surgeon, I treated each patient’s disease through surgery. However, when it comes to disease, prevention is more important than treatment. Public health plays an extremely central role in preventive medicine, which aims to prevent diseases, delay disease progression, and promote health. Public health serves as the institutional and social tool for realizing these preventive objectives.

My grand-uncle, Lee Ying-yuan, former Minister of the Environmental Protection Administration, could have chosen to study medicine at Taipei Medical College based on his university entrance exam scores. Yet, he chose to study Public Health at National Taiwan University because he believed that public health contributes to humanity even more than being a physician.

Although clinical medicine has many specialties — such as surgery, internal medicine, obstetrics and gynecology, pediatrics, etc. — the scope of public health is even broader. It includes promoting healthy diets and exercise, tobacco control policies, mental health promotion, vaccination programs, environmental sanitation improvement, air quality management, traffic safety regulations, and policy formulation.

Currently, one of the most discussed health policies is President Lai Ching-te’s “Healthy Taiwan,” which emphasizes prolonging healthy life expectancy and shortening unhealthy life expectancy. Professor Lo Wei-Cheng at the College of Public Health has conducted many systematic reviews and meta-analyses on risk factor monitoring, providing excellent reports on reducing complications and disability. Community health management through chronic disease education has proven to be more effective than simply getting medications from hospitals and clinics.

Dean Chen Yi-Hua’s research team studied patients’ healthcare utilization during COVID-19 in Taiwan. They found that when people avoided unnecessary medical visits to reduce infection risk, there was concern about a possible increase in cancer mortality due to delayed care. However, results showed no increase in cancer mortality. Interestingly, while overall visit numbers decreased, the point values for medical services actually increased significantly. This is remarkable real-world data and serves as an important reference for healthcare system reform in Taiwan.

I also saw Professor Kao Chih-Wen applying epidemiological concepts to early-stage lung cancer research, offering unique and in-depth insights that have been published in renowned international journals. Under preventive medicine principles, Taiwan emphasizes using low-dose CT scans for early lung cancer detection. Professor Kao holds differing views from mainstream clinical perspectives and has the courage to engage in public lectures and debates — something I greatly respect. Foreign literature shows that in some autopsies, small early lung nodules did not necessarily progress into the feared lung cancer. This research reminds us of the critical concept of potential overtreatment. These examples challenge the scope and mindset of both public health and clinical medicine.

Everyone knows that medical disputes are a very real problem today, leading to much defensive medicine. When I worked at National Cheng Kung University Medical College, I co-taught a required medical law course with Professor Hou Ying-Leng from the Law Department to help medical students understand the interaction between clinical practice and law.

While preparing for my speech, I reviewed the undergraduate, master’s, and doctoral curriculum of the College of Public Health and saw that students already receive excellent training in pure public health, especially in biostatistics. However, I believe it is crucial for students to also gain concepts in clinical medicine. I suggested to the dean that family medicine physicians be invited to teach a required course in the College of Public Health, introducing disease concepts of various organ systems. The dean agreed and said this would be discussed in the curriculum committee. I believe that once implemented, graduates entering policy planning or practical work will have a stronger sense of direction.

Taiwan’s National Health Insurance was originally planned and established by our public health predecessors. In practical operation, I believe the integration of clinical medicine and public health is truly the key to healthcare reform. The many bottlenecks faced by health insurance today cannot be solved simply by tearing down and rebuilding; instead, we must realistically face problems and make efficient adjustments.

As a transplant surgeon caring for patients for life, it is impossible to evade any patient issues. In my book Facing Humanity: Pragmatic Health Insurance Reform — What Taiwanese People Should Know About National Health Insurance, I candidly express my true feelings.

In recent years, having the opportunity to conduct research with many public health professors has made me even more aware that public health is the main force turning a nation’s vision into reality. I also hope the Healthy Taiwan Committee will invite more public health scholars to join future discussions.

Original Source: Liberty Republic, “Lee Po-Chang / The Integration of Clinical Medicine and Public Health is the Key to Healthcare Reform”

Rui-Hong Weng / President of the Taipei Public Health Association; Professor, Department of Public Health, Chung Shan Medical University

After reading Professor Lee Po-Chang’s article published on June 22 in Liberty Republic titled “Integrating Clinical Medicine and Public Health: The True Key to Healthcare Reform”, I felt a deep resonance and was greatly inspired. Professor Lee transitioned from his professional journey as a clinical surgeon to becoming a driving force behind Taiwan’s National Health Insurance system, and in recent years, has been actively promoting and advocating for public health education. His work spans clinical practice, system design, and academia. His statement that “the integration of clinical medicine and public health is the true key to healthcare reform” is both precise and visionary, offering profound insights.

Professor Lee emphasizes that if healthcare reform focuses solely on improving treatment efficiency or optimizing medical behavior, it will ultimately fail to address deeper challenges such as population aging, shifts in disease patterns, and health inequities. Only by institutionalizing and socializing “prevention,” “risk management,” and “health promotion” can we establish a truly people-centered and sustainable care system. Public health is undoubtedly a crucial foundation in this transformative process.

It is also noteworthy that Minister without Portfolio Chen Shih-Chung recently sounded an alarm regarding the continuous rise in National Health Insurance (NHI) expenditures, attributing it to the dual pressures of an aging population and declining birth rates. Minister Chen further pointed out that relying solely on premium adjustments will not sustain the system in the long run. Only through proactive “preventive medicine and health promotion” policies, which enhance public health literacy and delay disability and disease onset, can the financial structure of NHI be stabilized. This perspective aligns perfectly with Professor Lee’s advocacy for “clinical-public health integration.”

Looking back, the establishment of Taiwan’s NHI system was built upon the professional foundation and visionary insight of public health pioneers. Today, Taiwan faces numerous governance challenges, including an aging population, sharply declining birth rates, increased climate and environmental health risks, emerging infectious disease threats, urban-rural disparities, and multiple overlapping health inequities. We urgently need a health governance framework with a holistic perspective and a preventive orientation.

In 2020, Taiwan enacted the Public Health Specialist Act, laying a legal foundation for building a professional, credible, and institutionalized public health workforce system. However, within the current government structure, the titles and positions for public health specialists have yet to be fully established. Therefore, our association has made three concrete proposals to the Executive Yuan and Examination Yuan:

1. Explicitly establish the position and job title of “public health specialist” within central and local health authorities, social safety networks, schools, communities, and related organizations.

2. Establish a civil service examination system for public health specialists, providing young public health professionals with a stable career pathway.

3. Clearly recognize public health specialists as healthcare professionals, allowing them to collaborate with clinical personnel and implement integrated care that extends from treatment to prevention, health promotion, and long-term care.

Moreover, in areas such as school health, environmental risk management, and workplace health care, the role of public health specialists is also critical. For example, prolonged exposure to air pollution among schoolchildren may lead to worsened respiratory diseases and reduced attention in class, yet most schools lack air quality monitoring and health risk assessment capabilities. In workplaces, problems such as overwork, chronic diseases, and deteriorating health among aging workers urgently require public health approaches for evaluation and improvement. Public health specialists, with their systematic, interdisciplinary, and data-driven training, are the most suitable professionals to tackle these challenges.

Professor Lee also calls for the inclusion of clinical content, such as family medicine, in public health curricula—an idea with which I wholeheartedly agree. Public health education should not be detached from clinical realities; conversely, clinical professionals should deepen their understanding of social determinants, health inequalities, and population risk structures. Through this integration, we can cultivate public health leaders with a governance vision, practical skills, and empathy.

Healthcare reform is not merely about technological advancement; it is fundamentally a restructuring of system architecture and value logic. Professor Lee’s article not only demonstrates the rationality and warmth of a physician but also embodies the profound institutional reflections of an NHI practitioner. At this critical juncture, as the “Healthy Taiwan” policy is vigorously advancing, I sincerely hope that we can join hands with clinical, public health, and policy stakeholders to forge a future truly centered on health through system innovation and professional integration.

Related response article in Liberty Republic:
Rui-Hong Weng / In Response to Professor Lee Po-Chang’s Article / Integrating Clinical and Public Health for a “Health-Centered” Approach