Taiwan hospital reform debate puts staffing, public funding and financial transparency in focus

82 public hospitals face a question bigger than pay

Taiwan's 82 public hospitals held 45,150 beds at the end of 2025, according to Ministry of Health and Welfare figures. They represented 17.8% of hospitals but about one third of the country's 136,083 hospital beds. Their responsibilities include emergency care, services on remote islands, infectious disease control and treatment for people with few other options.

Now, proposals to loosen staff bonus rules and let some nurses work until 64 have opened a wider debate: how should Taiwan pay for hospitals that must balance their books while providing services that may bring little income?

Taiwan Healthcare Reform Foundation executive director Lin Ya-hui argues that higher pay and later retirement need to sit within a broader review of where medical resources go. She wants consistent financial disclosure, a fresh assessment of regional needs and clearer responsibilities for public and private hospitals.

The debate gathered force in November 2026 as hospital representatives described recruitment difficulties and the health ministry outlined changes to bonus rules. A proposed amendment is expected to be completed before the end of 2026 and submitted to the Executive Yuan for approval. Changes to retirement arrangements remain under discussion.

For patients, the issue reaches beyond hospital accounts. Funding and staffing decisions affect whether a local hospital can maintain demanding services, whether experienced nurses can train newcomers and whether people outside major cities can receive care close to home.

Public hospitals therefore face two linked pressures: competing for staff in the same employment market as private institutions and sustaining public duties whose value cannot be measured simply by the money they earn.

Why hospital ownership tells only part of the story

Taiwan's public hospitals belong to five main systems: the health ministry, the Veterans Affairs Council, the Ministry of National Defense, the Ministry of Education and local governments. Lin says their different rules and operating conditions make a simple public versus private comparison inadequate.

Private hospitals also have several legal forms, including foundations, associations and institutions established by individuals. Those arrangements affect how hospitals are governed and which financial rules apply.

Chen Wei-ming, chairman of the public hospital association, says hospitals across the five public systems operate through funds that require them to cover their operating expenses. Their ability to distribute performance bonuses depends on annual financial results and rules governing the amount set aside and its allocation.

Lin warns that asking institutions to finance themselves mainly through revenue can pull them toward services that earn more money. Remote care, outbreak preparation and support for vulnerable patients may struggle under that approach, even when communities depend on them.

The ministry's figures show why these institutions carry weight beyond their number. Taiwan had 378 nonpublic hospitals with 90,933 beds at the end of 2025. Public hospitals accounted for roughly one in six hospitals but one in three beds, making staffing and funding decisions within them consequential for the wider system.

How donated equipment can reduce staff bonuses

The health ministry is preparing an amendment to Point 4 of the guidelines governing incentive payments to public medical institution personnel. The proposal would adjust the ceiling on the total amount allocated to bonuses and relax conditions concerning depreciation of donated assets.

Depreciation means spreading the recorded cost of equipment across the years it is expected to be used. A machine may arrive as a donation, yet its annual depreciation can still reduce the operating surplus used to calculate bonuses.

Tsai Ching-yao, a deputy superintendent of Taipei City Hospital, illustrated the problem with equipment worth NT$10 million depreciated over 10 years. An annual NT$1 million accounting charge would reduce the surplus before a proportion is allocated to staff incentives.

Chen says this effect varies across public hospital systems. Equipment depreciation does not directly affect staff salaries at large institutions such as Taipei Veterans General Hospital and National Taiwan University Hospital, while it can reduce the surplus available for performance bonuses elsewhere.

Lu Nien-tzu, a senior technical specialist in the ministry's Department of Medical Affairs, says fixed public hospital salary structures make it difficult to respond quickly to changing prices and competing wages. The planned rules are intended to apply across public hospitals. The ministry is also considering higher consultation fees to encourage doctors to provide support at those institutions.

What a retirement age of 64 would change

The Veterans Affairs Council is considering raising the mandatory retirement age for eligible public service nurses in hazardous or physically demanding posts from 60 to 64. Their existing option to retire voluntarily at 55 would remain.

The arrangements concern qualifying posts, including nursing work involving three rotating shifts and regular exposure to risks to physical health, mental health or safety. The proposal concerns when eligible nurses must leave, while preserving their earlier retirement choice.

Chen Li-chin, president of the national federation of nurses' associations, supports that direction because it would give experienced nurses more flexibility to stay. She said nursing managers consulted across several public hospital systems supported the adjustment on the condition that voluntary retirement rights at 55 remain unchanged.

Hospital figures show why the distinction matters. Chen Wei-ming cited 76 nurses at Taipei Veterans General Hospital who retired under the reduced retirement age arrangements in the preceding year. At National Taiwan University Hospital, 33 nurses aged 55 to 59 applied for retirement, compared with four who reached mandatory retirement at 60.

Taipei City Hospital recorded 32 retirements in the figures he cited: 25 voluntary departures and seven at the mandatory age. Raising the compulsory age would give nurses approaching 60 another choice, while decisions to leave earlier would continue to depend on their circumstances.

Chen Ching-mei, deputy director of the ministry's Department of Nursing and Health Care, says the ministry will gather further views from public hospital systems before discussions with the Ministry of Civil Service. No implementation date has been announced.

A veteran nurse explains why staying is difficult

Yu Pai-fei, a cardiovascular surgery nurse practitioner with 37 years of service at Taipei Veterans General Hospital, had planned to retire at 55. Two years before her account appeared in November 2026, four of the seven colleagues in her unit, including Yu herself, had submitted resignations.

Yu ultimately stayed because students needed clinical guidance and younger staff needed experienced colleagues. Explaining her decision, she used an image of nurturing the people who would follow her. In translation, she said:

I stayed for the seeds of the next generation.

Yu says continuing departures increase the workload for those who remain. She wants better ratios between nurses and patients, higher pay and a more supportive workplace so experienced staff can pass on their knowledge and younger nurses will want to stay.

Lin makes a related point about the limits of retirement changes. The most severe shortages can occur in demanding hospital units with frequent shift rotations. Experienced nurses staying longer may contribute valuable skills without necessarily filling every vacancy in those settings.

Lin also calls for any retirement change to be assessed against occupational safety, workers' health and international experience. An older nurse's willingness and ability to continue working must be considered alongside the hospital's staffing needs.

Pay and workload are part of the same problem

A 2024 assessment, Sustainability and Resilience in the Taiwanese Health System, describes a workforce facing high stress, exposure to risk, long hours and inadequate pay. It reports that more than 74% of nurses worked between 40 and 60 hours a week and that average annual nursing pay was approximately US$21,700 in 2022.

The assessment also records nursing turnover approaching 12% in recent years and a practice rate of around 60% among licensed nurses in 2023. That practice rate describes the share of people holding nursing licences who were working in nursing.

New entrants were declining as well. The number of nurses beginning practice fell from 8,447 in 2021 to 7,527 in 2022, a drop of 920, or about 10.9%. Average seniority among practising nurses reached 14 years in 2022, the highest level in a decade, while enrolment in nursing programmes had fallen.

Chen Li-chin says a federation survey collecting more than 1,300 responses across hospital levels identified pay and workload as nurses' leading concerns. She calls for staffing ratios covering all three shifts, simpler work processes, training opportunities and greater workplace support.

Lin cautions that higher earnings can come from more night shifts or more intense work. Better pay can attract recruits, but keeping them also requires a manageable job. The 2024 assessment recommends regular workload reviews, enforcement of working hour protections, mental health support, salary subsidies and training.

Financial transparency already exists, but the debate goes further

The National Health Insurance Administration already operates a financial disclosure portal. Under regulations governing financial reports from contracted medical institutions, it publishes annual reports for hospitals receiving National Health Insurance payments above a specified amount.

The portal also provides bed numbers, outpatient and inpatient claim volumes, medical service points, average daily ratios between nurses and patients, and information about individual hospital quality. Users can search by year, region, contract category and hospital name.

Lin's proposal seeks consistent disclosure that allows operating costs, personnel spending and financial conditions to be assessed across hospital types and individual campuses. Such comparisons would help identify which institutions need support and what that support should fund.

The foundation's financial supervision statement documents the earlier struggle for public access to hospital accounts. It says only about 2.4% of hospitals publicly disclosed audit records in 2001. By 2004, 15 nonprofit hospitals had disclosed their 2002 financial reports, about 30% of the total, while none of those 15 had released reports for 2003.

The same historical account says the Department of Health released 2005 financial reports for 16 hospitals in 2006, representing about 29% of nonprofit hospitals. It also describes a proposed disclosure requirement dropped during Legislative Yuan negotiations in December 2004.

That history includes a hospital market becoming more concentrated: the foundation recorded a 30% fall in hospital numbers over the decade it examined, including about 167 private hospital closures, while hospitals operated by corporations increased from 24 to 50. The current disclosure portal represents a later stage in public access to financial information.

Public duties have carried a measurable cost for years

An August 2015 Legislative Yuan study by Lai Hsin-yi examined 26 health ministry medical institutions. Across its figures for 2012 to 2015, operating revenue ranged from approximately NT$24.96 billion to NT$27.34 billion.

After government budget subsidies were removed, the institutions recorded annual shortfalls ranging from approximately NT$2.44 billion to NT$2.74 billion. The study used audited accounts for 2012 and 2013, institution prepared accounts for 2014 and a proposed budget for 2015.

The study connected these hospitals to remote and island services, community care for people with dementia or disabilities, treatment for vulnerable groups, infectious disease control and psychiatric care. It also recorded a physician vacancy rate exceeding 20% in August 2014.

Its description of hospital roles anticipated today's discussion about dividing responsibilities. Regional hospitals were to concentrate on acute and critical care, with elderly care and long term care as supporting functions. District hospitals were to place greater weight on elderly care and long term care, supported by cooperation among institutions.

The 2024 health system assessment describes another financial constraint: National Health Insurance's global budget, which limits total spending. Such a budget controls costs, but the assessment says fixed funding can restrict responses to changing needs and investment in staff or technology, while encouraging service volume rather than quality.

Regional planning must connect money to access

Taiwan has operated medical network plans since 1986. These divide the country into areas for planning facilities, staff and services. A 2020 budget assessment by the Legislative Yuan's Budget Center found that substantial geographic gaps persisted after more than three decades.

Using January 2020 figures, the assessment recorded 21.06 doctors per 10,000 people nationally, compared with 6.83 in mountain Indigenous townships, 9.43 on offshore islands and 3.81 in highly remote areas. The last figure was about 18% of the national average.

The assessment also found that 30 mountain Indigenous townships had no hospitals in the institutional data it examined. An August 2020 emergency hospital list showed no hospital with the highest emergency capability designation in Lienchiang, Kinmen, Penghu or Nantou counties. The proposed 2021 budget allocated NT$732.05 million to medical network programmes across the ministry and its agencies.

The 2024 health system assessment adds a later measure of geographic inequality: life expectancy in 2022 was 76.46 years in Taitung County and 83.75 in Taipei, a gap of 7.29 years. It recommends addressing the uneven distribution of medical professionals with sustained pay protection and better working conditions in remote areas.

Several milestones show how the current proposals fit into a longer policy debate:

• 1986: Taiwan began implementing medical network plans.
• August 2015: A legislative study documented ministry hospitals' financial shortfalls before subsidies and their public service duties.
• October 2020: A budget assessment identified continuing gaps in remote and island medical capacity.
• 2024: A health system assessment recommended greater investment in staff and regular workload reviews.
• November 2026: The debate focused on bonus flexibility, retirement choices and broader resource allocation.
• Before the end of 2026: The ministry expects to complete the bonus amendment and submit it for Executive Yuan approval.

Lin's proposed response brings those issues together: reassess population changes and medical needs in each region, assign complementary roles to public and private hospitals, and match those responsibilities with funding. For patients and staff, the practical goal is a hospital network that can sustain necessary care without relying on an increasingly exhausted workforce.

Key Points

• Taiwan's 82 public hospitals held 45,150 beds at the end of 2025, about one third of all hospital beds.
• The health ministry plans to complete proposed changes to public hospital bonus rules before the end of 2026.
• A retirement proposal would raise the mandatory age for eligible nurses from 60 to 64 while preserving voluntary retirement at 55.
• Nursing representatives identify pay, workload, staffing and workplace support as central to retention.
• Financial reports are already published through the National Health Insurance Administration; reform advocates seek consistent comparisons across institutions and campuses.
• The Taiwan Healthcare Reform Foundation wants regional planning and funding to reflect hospitals' public duties as well as their financial results.