International Center for Advances in Health Systems Management 

Background 

Since the fall of 1994, the School of Public Health at Saint Louis University (SLU) has been actively involved in the provision of graduate-level health care management education in Taiwan, R.O.C. Prior to that time, a small number of Taiwanese students had previously come to the USA to study on the SLU campus in order to earn the Masters of Health Administration (MHA) degree in the full-time program. However, in the mid-1990s, the decision was made to design and implement an executive-format version of the MHA degree specifically designed for the needs of practicing Taiwanese health care clinicians and managers. This new MHA program has been offered since January 1995 to five successive cohorts of students in Taiwan. Courses in this two year program have been either offered on-site in Taiwan during the winter-spring or on the SLU campus during three-four week summer sessions. A local agent has been employed by SLU to assist in marketing and logistical support. Major features of this program included:

• use of an innovative executive-format of instruction,  

• the introduction of distance-based learning technology,  

• a comparative perspective that included a dual focus upon both the         Taiwanese and American delivery systems and  

• exposure to a wide range of substantive topics, applied management     skills and cutting-edge issues that are nearly identical to the courses which are offered in the main campus, full time program.    

Over 75 Taiwanese health care professionals have entered this program since its inception and the fourth cohort graduated in July 2000. A fifth cohort entered the program in the summer of 2000 and will graduate in 2002. Even when viewed from a variety of perspectives (students, faculty, alumni, employers), this new program has been quite successful. However, continuing changes in Taiwan during the 1990s have also clearly suggested new challenges and opportunities that are certainly worthy of consideration. 

The health care delivery system in Taiwan during the 1990s has experienced a great deal of growth, development and change in numerous areas. Examples of major issues include the following:   

• The rapid development and implementation of a very comprehensive National Health Insurance (NHI) system. This policy initiative has dramatically affected patient access, service utilization and health care costs. This trend includes a gradual shift away from traditional fee-for-service insurance coverage toward prospective payment methods initially and then eventually the introduction of managed care and capitated payment in Taiwan probably within three-five years.  

• Partially if not largely due to the introduction of the NHI, Taiwanese health care organizations are currently facing considerable pressures to rapidly and significantly improve both their levels of operating efficiency and the quality of service outcomes ranging from consumer satisfaction to improved health status. This need to “produce more for less” is certainly a very difficult challenge.    

• The 1990s have also witnessed very rapid and widespread diffusion of numerous clinical and managerial technologies in Taiwan. Probably because of the global information revolution and Taiwan’s excellent access to technical expertise and information, many types of clinical techniques and equipment from office-based surgical advances to PET scanners have quickly spread from other parts of the world especially Western Europe, Japan and the US to health care providers in Taiwan. The same can be said for new advances in information systems, standards-based cost accounting systems, quality assurance standards and other examples of significant new managerial tools.  

• Another important area of change in Taiwan has been the rapid growth of interest in the general area of continuous quality improvement (CQI) concepts and tools. This has directly led to the creation and implementation of evolving national quality standards at the hospital level and indirectly to increased market-based competition based on consumer perceptions of quality. As in the US, pressures to decrease costs often simultaneously raise concerns about potential adverse effects on the quality of services that are offered. Thus, this will likely continue to be an important area of interest well into the future.  

• Finally, perhaps because of the pressures and developments regarding costs and quality that have already been mentioned, more clinicians are entering managerial roles in Taiwanese health care organizations. Thus, even though they may have little if any formal education or training in health care management, doctors, dentists and nurses are becoming increasingly involved in managerial decision making within contemporary Taiwanese health care organizations.    

These developments that have occurred within Taiwan’s health care system have led to many changes including the rapid growth and expansion of the health care management profession. This trend is exemplified by numerous indicators such as: the increased numbers of MHA programs in Taiwan (both domestic and foreign) and their graduates, increased employment of MHAs within health care and new programs that have recently been created to offer courses in health care management and related areas to practicing health care managers and clinicians who are not enrolled in full-time academic programs.  Such widespread changes within Taiwan’s health care system contain major implications for the education and training of health care managers. Namely, they offer new opportunities for program-development in a wide range of areas including but not restricted to: academic instruction in health care management, professional development programs for practicing health care managers, applied service-based consultation to health care organizations and health services research including outcomes research. 

Within the context of the University’s goal of becoming the best Catholic Jesuit institution in the United States, the School of Public Health created the International Center for Advances in Health Systems Management [ICAHSM] in 1999.  The focus of ICAHSM is to develop innovate educational, research, and consultation in health services administration for international health care professionals.