A Costly Illusion? An Empirical Study of Taiwan’s Use of Isolation to Control Tuberculosis Transmission and its Implications for Public Health Law and Policymaking

The resurgence of tuberculosis (TB) and the emergence of multidrug-resistant TB have resulted in the detention of patients in a number of international jurisdictions since the 1990s, including in Taiwan. The Taiwanese government adopted isolation as an official policy to control TB’s spread in its 2006 Ten-Year Mobilization Plan, whose goal is to halve TB incidence from 66.7 per 100,000 persons to 34 per 100,000 persons. The isolation program allows treating physicians to nominate patients for isolation while public health officials may also isolate patients if necessary. Hospitals providing care to isolated patients would be reimbursed from the budget of the Centers for Disease Control (CDC) based on payment standards set by the National Health Insurance program (NHI) rather than from the NHI’s pool based on floated point-values under the NHI’s global budget scheme. An empirical study was designed to specify how Taiwan’s stated isolation regulatory scheme was implemented during its first three years (2006-2008). Results were then examined for relevant implications for public health law and policy in Taiwan using Lawrence Gostin’s evaluation framework for public health regulation. Qualitative semi-structured interviews were conducted between March and July 2009 with two groups: local health officials (fifteen individuals from ten local health administrations) and health care workers at hospitals designated for isolation (fourteen individuals from