AmCham Taiwan Healthy Aging Forum:
2025健康台灣樂齡論壇:公私協力促進全人健康
AmCham Taiwan Healthy Aging Forum:
2025健康台灣樂齡論壇:公私協力促進全人健康
Committee Events & Luncheons
Suggestion: Devise a practical plan to legalize the profession of chiropractic as most other countries in the world have done.
Frustratingly, the question of how to recognize the legitimacy and value of the profession of chiropractic in Taiwan remains unresolved. This is now the 19th consecutive edition of the annual Taiwan White Paper in which the issue has been raised by the chiropractic doctor members of AmCham Taiwan without seeing any significant progress.
The Ministry of Health and Welfare’s (MOHW) response to last year’s White Paper submission was that there is no need to recognize chiropractic as part of Taiwan’s healthcare system since “an ample supply of medical personnel already exists” with the capability of providing equivalent treatment. The view appears either to equate chiropractic with traditional Chinese bone-setting or regard it as merely a technique that can be easily learned by those with medical training.
That notion represents a basic misunderstanding of the nature of chiropractic, which is identified by the World Health Organization (WHO) – which Taiwan aspires to join – as an entirely separate discipline from Western medicine, Chinese medicine, and physical therapy. In fact, according to the WHO, even medical doctors would need to undergo 2,200 hours of specialized training to be capable of properly performing chiropractic treatment.
In depriving its citizens of easy access to that healthcare option, Taiwan is doing a disservice to the public. It is particularly unfortunate at a time when Taiwan’s soon-to-be super-aged population requires increasing healthcare attention, placing a growing burden on the country’s resources. Already, Taiwan is experiencing a serious shortage of physicians and nurses. Relieving the various physical ailments caused by vertebral misalignment, chiropractic spinal manipulation has the benefit of involving neither surgery nor medication.
In countries such as Australia, Canada, New Zealand, the United Kingdom, and the United States, chiropractic doctors need to study for five years after earning a bachelor’s degree and then pass a strict licensing exam before they can practice. In the absence of both chiropractic departments in Taiwanese universities and a domestic licensing system, many Taiwanese people have gone abroad to study chiropractic and receive their professional accreditation, only to return to their home country to find they have no recognized status.
Over the years, the authorities have insisted that chiropractic cannot be legitimized until such a formal course of study has been established by domestic educational institutions and an examination and licensing system set up to qualify its graduates. But this requirement represents a classic catch-22 situation. Attempting to follow up on the MOHW’s request, the Taiwan Chiropractic Doctors Society found potential interest by Taiwanese educational institutions in setting up chiropractic departments, but unwillingness to make the investment without a guarantee that their graduates would receive full professional recognition. At the same time, the authorities are unwilling to create a certification process until the discipline is taught in domestic colleges or universities.
Why has Taiwan faced this impasse when more than a hundred countries around the world have found a way to recognize chiropractic and take advantage of the healthcare benefits it has to offer? In most of those cases, the domestic authorities were in the same position as Taiwan has been. Traditionally, chiropractic did not exist in their society, but they had the flexibility and creativity to devise a method to legitimize doctors of chiropractic who had appropriate training abroad.
To cite just a few examples from the Asia-Pacific region, in 1993 Hong Kong’s Legislative Council authorized creation of an advisory Chiropractors Council and with its help drafted and enacted a Chiropractors Registration Ordinance, creating a pathway for foreign-educated chiropractic doctors to be licensed after proving their professional competence and high ethical standing.
A 2006 declaration by Thailand’s Ministry of Public Health set out criteria for the licensing of chiropractic, including graduation from an approved chiropractic college and passage of a local examination. The stated objective was to protect the public from harm by ensuring that chiropractic treatment is given only by qualified practitioners who have received extensive training.
In the Philippines, the government relied on support from the Philippine Institute of Traditional and Alternative Health Care to establish a National Certification Committee for Chiropractic, which began to approve applications from qualified practitioners in 2010.
In the Thai and Philippine cases, the effort received support from the medical community, with physicians serving as members of the examining boards along with chiropractors and educators. In the United States and many other countries, by contrast, chiropractic doctors often serve on the staff of hospitals and clinics, joining medical doctors and physical therapists on teams providing patients with holistic care.
In a country as innovative as Taiwan, and one that has shown its dedication to universal healthcare, surely a way can be found after nearly two decades to overcome any lingering opposition and resolve the longest-standing issue in the Taiwan White Paper.
In recent years, it has become common – in Taiwan and in many countries – to give an innovative approach, a trial through a “sandbox” in which existing regulatory constraints are temporarily waived. Perhaps it is time to create a sandbox for chiropractic to demonstrate its benefits for Taiwanese patients.
建議:比照全球多數國家,制定一個可行的計畫將脊骨神經醫學專業合法化
關於如何認定脊骨神經醫學在台灣之合法性和價值目前仍然懸而未決,令人遺憾。這已經是台灣美國商會的脊骨神經醫師會員們連續第19年在台灣白皮書中提出此問題,卻未有任何顯著進展。根據去年衛生福利部對白皮書的回應:由於現今「已有充足的醫療人員」能夠提供同等的治療,因此無需將脊骨神經醫學認定並納入台灣醫療體系內。這種觀點不單是將脊骨神經醫學視為傳統中醫整骨,同時也只將其視為一種技術,認為只要有受過醫學訓練者皆能輕易學會。
這種看法是對脊骨神經醫學有本質上的誤解。世界衛生組織(WHO)— 一個台灣極其期待加入的組織 — 明確將脊骨神經醫學定義為與西醫、中醫和物理治療完全不同的專業。實際上,根據WHO,即使是西醫師也需要接受2200小時的專門訓練,才有能力正確進行脊骨神經醫學的治療。
有鑑於此,台灣的現況可謂有損公眾利益,因為政府無法給予公民獲得脊骨神經醫學服務的權利,尤其台灣即將邁入「超高齡社會」,長期照護需求將不斷增加,對於國家資源是一個日益沉重的負擔。台灣目前已經面臨醫師和護理師的嚴重短缺,脊骨神經醫學的脊椎矯正恰可緩解由脊椎不正引起的各種身體疾病,且有不涉及手術和服用藥物之益處。在美國、加拿大、英國、澳洲與紐西蘭等國家,脊骨神經醫師需在獲得學士學位後繼續學習五年的醫學教育,並通過嚴格的執照考試才能執業。由於台灣的大學缺乏脊骨神經醫學科系,國內也無認證制度,許多台灣人在出國學習脊骨神經醫學並獲得專業資格回國後,卻發現他們沒有醫事人員認可的窘境。
多年來,台灣政府持續認為,脊骨神經醫學的合法化需要在國內教育機構設立正式的脊骨神經醫學課程,並建立考試和執照制度,但這要求形成了典型的因果困境。為了符合衛福部的要求,台灣凱羅健康協會(脊骨神經醫學會) 發現,雖然台灣教育機構有興趣成立脊骨神經科系,但他們並不願意在無法保證其畢業生能獲得完整專業認可的情況下進行投資;於此同時,政府認為若該學科尚未在國內教育機構被教授,他們無法建立相關認證流程。
在台灣面臨此一僵局的同時,全球超過一百個國家已經找到方法認可脊骨神經醫學並獲得其帶來之益處,在這些案例中,許多國家的政府面臨與台灣類似的情況,即過去脊骨神經醫學在他們的社會中並不存在,但他們以彈性且創新的方式使經過國外適當訓練的脊骨神經醫師得以合法執業。例如1993年,香港立法會授權成立了脊骨神經醫師諮詢委員會,並在其協助下起草並通過了脊骨神經醫師註冊條例,在擁有專業訓練證明和高道德標準證明(沒有任何犯罪紀錄或前科)的前提下,為受過外國教育的脊骨神經醫生提供了獲得執照的途徑;2006年,泰國公共衛生部發布聲明,制定了脊骨神經醫學執照的規範,包含從被認可的脊骨神經醫學院畢業並通過當地國家考試,其目的是為了保護民眾免於傷害,僅有受過嚴謹訓練並符合資格的執業人員才能提供脊骨神經醫學治療;而在菲律賓,政府仰賴菲律賓傳統暨替代療法研究院(Institute Of Traditional And Alternative Health Care)的協助,於2010年成立了脊骨神經醫學的國家認證,開始批准合格從業者的申請。
在泰國和菲律賓的案例中,這些政策獲得醫療界的支持,並由西醫師、脊骨神經醫師及教育者共同擔任考試委員會的成員。在美國以及許多其他國家,脊骨神經醫師常與西醫和物理治療師在醫院與診所共同為患者提供全方位的照護。在台灣這樣一個追求創新且致力於醫療普及化的國家,肯定能找到方法克服反對意見並解決這個在白皮書中持續近二十年的問題。台灣近年來和國際許多國家一樣,普遍透過「沙盒」進行創新試驗並暫時鬆綁現有的監管限制,現在正是時候為脊骨神經醫學創建一個沙盒,以顯現其對台灣病患之益處了。