Article 25 Health
Unfriendly Medical Services Prevents PWDs from Using Medical Resources (Response to Paragraphs 190, 211, and 212 in the State Report)
Seeking Medical Treatment: The State has yet to mandate barrier-free accessibility for regular medical clinics. There are often steps to the entrance of many clinics and narrow spaces in clinics. Treatment tables also tend to have limited flexibility for adjustment. Article 24 of the People with Disabilities Rights Protection Act demands that each county and municipality designate special clinics for PWDs based on the population of PWDs and their needs. However, only dental services have currently reached the target of having at least one special clinic per county or municipality.10
Consultation: Despite the fact that the “Regulation for Managing Special Medical Consultations for Persons with Disabilities Regulation” stipulates that hospitals need to establish procedures that are convenient for PWDs to access, but medical personnel are insufficiently familiar with the uniqueness and variety of disabilities. Moreover, the medical conditions of PWDs are often complex: They often need to attend several consultations in one visit, and do not have the physical stamina to bear long periods of waiting. There should be the provision of friendlier consultation processes for persons with severe disabilities. For example, there should be the provision of more convenient procedures for follow-up visits by PWDs who require life-support systems twenty-four hours a day. Additionally, most clinics only have one waiting room. During crowded periods, this situation can intensify anxieties among persons with emotional disabilities, while raising the risk of secondary infection among PWDs weakened by illness and already at risk of infection (especially children). Such PWDs often see their medical conditions worsen as they are unable to successfully seek treatment.
Hospitalization: Most PWDs need special spatial arrangements, equipment, and personnel assistance during hospitalization. Such resources are currently limited. For example, wheelchair users need larger hospital rooms, which increases the financial burden of hospitalization on them since the National Health Insurance currently does not provide for accessible hospital rooms. A PWD will therefore need to pay out-of-pocket cost for a single or double room. Patients with serious scoliosis who lie down for long periods require air mattresses to reduce pressure and prevent bed sores and other conditions from developing. PWDs with weak muscles regularly face difficulties in operating hospital emergency call buttons and are unable to seek help from medical personnel in a timely manner. Hospital rooms that only provide seated shower seats and access chairs are inaccessible to persons who are unable to adopt suitable postures. Bathing and the use of toilet facilities present another major challenge. According to current regulations, PWDs are unable to apply for community support service personnel (such as residential services and personal assistant services) to provide support during hospitalization. This seriously affects the rights of PWDs to health and quality of life.
We recommend:
Hospitals should ensure that waiting rooms, consultation rooms, instruments, and equipment meet the needs of PWDs. These include wheelchair accessible, access assisted changing rooms as well as separate and quiet waiting rooms for the use of PWDs who require emotional stability.
All hospitals should provide a suitable proportion of safe and accessible hospital rooms under the National Health Insurance scheme. Hospitals should install care beds, air mattresses, and bathing beds suitable for PWDs with different needs in bathrooms. The design of the emergency call buttons in hospital rooms should consider the need of patients without sufficient strength in their arms. Hospitals should have communications facilities that enable PWDs to convey their needs to medical personnel with ease.
According to Article 23 the “Physically and Mentally Disabled Citizens Protection Act,” hospitals need to provide a discharge plan that includes recommendations on home care, physical therapy, home environment improvement, assisted device assessment and usage, transition services, lifestyle rebuilding, psychological counseling services, as well as an introduction to community treatment resources and other matters relating to hospital discharge. We recommend a legislative amendment to include a section on “Hospital Discharge and Recovery Follow-Up” to encourage hospitals to continually grasp recovery conditions, and to provide timely advisories as well as recommendations.
PWDs who use breathing aids may receive financial assistance from the National Health Insurance Bureau under the “Citizen National Health Insurance Comprehensive Advance Payment for Care of Persons Dependent on Breathing Aids” pilot program. However, the pilot program excludes residential care organizations (Residential Care Centers). The National Health Insurance Bureau should provide an explicit list of supplies that the government should provide under the pilot program, and implement regular visits and inspections to prevent inconsistency in the provision of services by residential care centers, which could affect the rights of PWDs.
Insufficient medical resources in rural incarceration facilities: PWDs held at incarceration facilities in rural areas such as Green Island, Taiyan, and Yanwan face higher health risks and risk of death. The remote locations of these facilities, where access is susceptible to weather and sea conditions, create challenges for communication and transport. Medical facilities in these areas also lack personnel and resources. Such conditions are contrary to Article 75 of the “Physically and Mentally Disabled Citizens Protection Act,” which stipulates that PWDs should not be kept in environments where they face the risk of danger or harm.
Right to Insurance for Persons with Disabilities (In Response to Paragraphs 78 and 210 of the State Report)
Most PWDs are excluded from commercial insurance due to discrimination: Under Article 7 of the “Insurance Industry Solicitation, Underwriting, and Claims Handling Methods” issued by the Financial Supervisory Commission of the Executive Yuan, insurers cannot treat clients unfairly even if they are PWDs. In practice, insurers tend to produce risk assessment data that have no medical or scientific basis, and are only willing to insure PWDs whose disabilities did not result from illness (for example, insurers tend to reject persons with persistent epilepsy), regard disabilities as illnesses and reduce coverage, or refuse coverage for risks and conditions unrelated to a person’s disability (such as insurance for cancer). Persons under guardianship for intellectual or psychological disabilities are also unable to purchase personal or group insurance. The Financial Supervisory Commission encourages insurers to offer “micro life insurance policies,” but the terms of these policies tend to be annual and no different from regular accident insurance. Such policies have insufficient coverage and untransparent premiums, resulting in differential treatment of PWDs.
For example, there was a lady who had been surgically cured of epilepsy, but was nonetheless required by the insurance company to provide medical proof that there would never be epilepsy attacks, otherwise her premium would be increased. Agents in the insurance company revealed that the company were not willing to cover clients with epilepsy because it was difficult to differentiate the causes of incidents and the probable contribution of epilepsy.
The government should prohibit the insurance companies from arbitrarily declining clients with disabilities. Medical experts and insurers should participate in consultations on how to establish standards for calculating and estimating appropriate premiums for PWDs with different types and degrees of disability. For example, since there is a wide range of symptoms for epilepsy, the nature of risks and dangers encountered will vary accordingly. The Financial Supervisory Commission should invite the four main insurers in Taiwan along with the Taiwan Epilepsy Society and related epilepsy societies, practitioners with experience of caring, and patients & their families to jointly discuss reasonable ways to insure persons with persistent and regular epilepsy.
Preventive Care, Pregnancy, and Childbirth for Disabled Women Ignored
Women with disabilities face difficulties finding community-based preventive care services: The Health Promotion Authority under the Ministry of Health and Welfare, together with the health bureaus, health offices, and hospitals of each county and municipality have adopted “Mammography Vehicles,” “Pap Smear Vehicles,” and other similar programs to tour communities and provide cervical and breast cancer screening. However, these touring vehicles all have steps, which prevent women with disabilities from boarding and receiving the appropriate screening. Further, mammogram devices on these vehicles only operate on standing individuals. If women with disabilities wish to go to a hospital or health center for screening, the limited number of rehabilitation and health buses that provide transportation for PWDs mean that seeking preventive treatment remains inconvenient. We recommend the Ministry of Health and Welfare gather data on number and proportion of women with disabilities who receive health check-ups, breast cancer screening, and cervical cancer pap smears to improve barrier-free access to medical facilities and equipment (including medical examination equipment and instruments, community touring screening vehicles, and shuttles for community hospitals etc.).
Women with disabilities are not expected to become mothers and consequently do not easily receive health information and adequate service: Pregnancy, childbirth, and postnatal care for women with disabilities are even more challenging to access when compared to women without disabilities. The design of examination tables, delivery tables and related equipment are ill-suited for use by women with disabilities across the board. Pregnancy health education, postnatal infant information, and related material tend to be unsuitable for use by women with disabilities. Designers seem not to have fully considered the needs of women who have special visual, intellectual, and physical needs.
The right of reproductive and childbearing autonomy for women with disabilities are ignored. We recommend that the Ministry of Health and Welfare collected and publish statistical data on the number of women with disabilities who underwent forced sterilizations or non-voluntary abortions.
We recommend that the Ministry of Health and Welfare strengthen education and training for medical personnel through multi-media materials. This allows medical personnel to provide women with disabilities with adequate health education relating to pre- and postnatal services (including infant care information).
Right to Health of a Child
In response to Paragraph 30 of the State Report, although the Government has permitted the establishment of children’s hospitals, the clinical environment remains insufficiently friendly for children with disabilities.
Currently, the “Children’s Hospital Assessment Criteria and Quantification Scheme” has explicit stipulations relating to barrier-free access, but has no explicit requirements on the specialized facilities that children with disabilities may need when seeking medical attention. For example, during ophthalmology consultations, children with disabilities need to be carried and shifted around physically by parents to use testing equipment. Orthopedic doctors require children who have weak muscles from serious scoliosis to sit upright to undergo x-rays, ignoring their difficulties. Currently, only small-sized beds for infants and small children have restraint bars that can be raised to prevent falls, but there is a lack of medium-sized beds with a similar capability for smaller-sized middle school-aged children. Hospitals also lack communication equipment to effectively convey the intentions during consultations and hospitalization of children who are conscious but unable to speak or have no control over their bodies.
We recommend that the “Children’s Hospital Assessment Criteria and Quantification Scheme” should include equipment to assist children with disabilities during medical treatment as part of its assessment standard, and incorporate improvements to such facilities as key criteria for annual assessments.
Please see Article 7, Paragraphs 37-41 of the Report for early intervention and education for children.
Sexual Rights of PWDs
Sexual rights are universal human rights, but the sexual rights of PWDs are often ignored: The State Report only emphasizes efforts at preventing sexually transmitted diseases (STDs), but has yet to adopt active attempts to recognize, promote, respect, and protect the sexual rights of PWDs. According to the 2011 Assessment Report on the Conditions and Needs of PWDs, 48.47% of PWDs have spouses or live-in partners. This data allows the presumption that slightly less than half PWDs have regular sex partners and sex lives. PWD service organizations in Taiwan have long distanced themselves from discussing the sexual rights of PWDs. It was not until 2013 when two gay activists (one of them a PWD) started ‘Hand Angels’, an organization that facilitate volunteer providing masturbation services to people with severe disabilities, that the call of ‘sexual rights is human rights’ was brought to realization for PWDs.11
Recommendation:
The Government should produce additional chapters on PWDs in sex and sexuality education curricula in schools, acknowledging the importance of sexual rights for PWDs. Additionally, the Government should increase personalized assistance and services relating to sexual needs based on age, gender, and other factors in current PWD benefits and services.
The Government should follow Supreme Court Ruling No. 666, including going through “Reasonable and Clear Controls and Penalties” to regulate sexual services only when absolutely necessary. We ask local governments to expedite the establishment of sexual service areas under Article 91-1 of the “Social Order Maintenance Act” to provide venues where persons can satisfy sexual needs. With regard to PWDs with more limitations on mobility and no financial ability, the Government can consult legislative examples from the United Kingdom and Europe to allocate a budget that allows sexual services to be included as part of the benefits for PWDs.
- See the “Chart for Special Dental Clinics Designated by the Health Bureau in each County and Municipality” issued by Ministry of Health and Welfare in 2011.
- Translator’s note: for more information about the Hand Angels, please check their official website at www.handjobtw.org.