Everyone knows that hospitals are profitable enterprises. But how much do they actually earn? One doctor in the business reveals that a private clinic where business is pretty good has a net income of NT$500,000 per month. A general hospital of about 100 beds or so which is properly run can have NT$2-3 million net income per month. As for those hospitals that hire unlicensed nurses, allow senior assistants to serve as doctors, and are unwilling to invest in equipment, their profits are even greater.

The Tsu-chi Buddhist General Hospital has more than 640 beds, 130 doctors, and more than 400 nurses. It is a rather large regional hospital. Nevertheless, in the seven years since that hospital opened, it has continually run losses. In the 1992 fiscal year, the figure reached N$15 million for unpaid debts owed by patients on payment schedules alone, and this doesn't even include those patients who simply up and left with no provisions for paying at all.

Many people identify with Master Cheng Yen because of her ideals. The photo shows Tsu-chi committee members waving goodbye to Cheng Yen at the train station.

A different kind of hospital:

Every type of enterprise hopes to be profitable, including hospitals. The operating ideal of the Tsu-chi Hospital to "only pursue balanced accounts, not seek profit" comes from the original ideal behind constructing the hospital of Buddhist Master Cheng Yen.

In 1966, the Master went to the hospital in Fenglin in Hualien County to visit patients there. At the hospital door she saw traces of blood and learned that there had just been a pregnant woman who had been refused entry into the hospital because she could not deliver the NT$8,000 guarantee payment. Besides being quite shocked, she also came up with the notion to build a hospital to benefit poor patients; and she could see that the medical resources in eastern Taiwan were inadequate and that people had to undergo long journeys to seek treatment. This strengthened her will to build a fully equipped hospital in Hualien.

In August 1986, the Tsu-chi Buddhist General Hospital formally opened. Director Tseng Wen-pin pointed out that the credo of the Tsu-chi Hospital is "compassion finds joy in giving." In this hospital which brings together the love of many people, it is not permitted to violate the spirit of this credo no matter what. Given this ideal, Tsu-chi does not use the guarantee deposit system for staying in hospital. No matter whether a person has money or not, if they are ill they will not be turned away.

In September 1989, a child of just over 5 who had been run over by a truck and was spitting blood and whose face was as white as a sheet was sent to the Buddhist Hospital. "The child was sent in for emergency treatment immediately upon arrival. The medical personnel were taking blood samples and running blood transfusions to stabilize the blood pressure while at the same time listening to the child's mother relate how the injury occurred. When everything was taken care of, the child was sent into surgery; it took less than 10 minutes from start to finish. In this process they only asked the child's name; the family did not have to do any procedures nor pay a nickel," says a Dr. Lin who witnessed the incident. Afterward the mother of this child thanked the hospital profusely. She knew if this were another hospital, by the time she had produced the deposit for her child and handled the necessary procedures, the child would have been dead.

A doctor and a patient discuss the case closely; you don't see such scenes too often in other hospitals.

A humanistic hospital:

Besides not requiring a guarantee deposit, Tsu-chi does not collect any preparatory fee for expensive treatments or examinations or anything for patients staying at the hospital, such as a CAT scan costing NT$6,000-8,000 or even magnetic imaging which cost more than NT$10,000. Tseng Wen-pin points out that at present some hospitals have also eliminated their collection of a guarantee fee for staying in the hospital but virtually all hospitals use preparatory fees.

Further, the doctors at Tsu-chi can use medications or go all out to treat their patients without worrying; they don't wonder whether or not patients can pay.

Tung Hsu-chin, Director of the Department of Social Services, explains that because there is a cap on the amount paid by civil service or labor insurance, most hospitals require that doctors take that into account and balance off the price of any prescription. If the medication is too expensive or the insurance will not pay, and the patient also cannot deliver, some hospitals will even require the doctors to make up the amount lost.

In this respect, Tsu-chi provides doctors with absolute respect. Lai Yu-chia, a doctor in the Department of Family Medicine, states that the only question is whether the medicine is needed or the examination should be done, then Tsu-chi's doctors have no need to consider limits on the ability to pay. "This is a result of the environment, and doctors who come here will naturally do it this way," laughs Dr. Lai. He himself had a different method when at a different hospital: "Working in a hospital where they keep meticulous track of costs, cost is the foundation of everything," he says helplessly.

Further, because payments provided by civil service or labor insurance are too low, some hospitals will increase the costs of medication sold to private patients by 20% or 30% to make up the difference. But the standards at Tsu-chi for the average self-paying patient use the lowest prices set under the labor insurance scheme. Tseng Wen-pin explains, "patients who pay themselves already have no other assistance, so to increase their fees for treatment is like 'frost on top of snow.'"

Patients have even higher expectations toward a religiously affiliated hospital than toward ordinary hospitals, so the hospital gives the patients greater spiritual support.

Compassion for everything:

As for financially strapped sufferers of illness, Tsu-chi offers free treatment.

Tung Hsu-chin states that because the fine reputation at Tsu-chi has become widely spread, the hospital gives people the impression of being a "charitable institution." Many sick people with serious illnesses or incurable illnesses who can not pay their medical bills will in the end be given a suggestion by other hospitals: "Go to the Tsu-chi Buddhist General Hospital!" "Some hospitals even send ambulances or pay transportation costs to send their patients to Tsu-chi," she says. One patient suffered spinal damage as a result of an accident. Because he lacked medical funding and also had no family to look after him, a Taichung Hospital sent an ambulance to take him all the way to Tsu-chi. After a period of treatment at Tsu-chi, they also found him a recuperation institution.

For remote areas where treatment is not easily accessible, the hospital's Departtment of Family Medicine works with volunteers to organize a roving medical team, which goes deep into poor remote areas to deliver free care to the people. Dr. Lai Yu-chia has just completed a half-year stint on the roving volunteer team. "In the past half year, we usually had the doctor as the driver temporarily set up a table as the examination table and take patients right at the front of the temple," he states. This scene is one that he never imagined while working as a physician in Taipei.

In terms of adding new equipment, Tsu-chi has never considered costs. Taking for example a new piece of equipment for kidney stone patients, Director Tseng states that it was purchased in order to provide the best possible care. Although only a small number of people will use this extremely expensive equipment, so that it does not really meet so-called "cost effectiveness, " when buying medical equipment, Tsu-chi only asks whether or not it is needed, and not whether or not it will be profitable.

This woman, who was left completely paralyzed by a failed operation and was refused entry by many hospitals, has gradually regained her spirit under the care of Tsu-chi doctors and volunteers. When she heard about how the volunteers had looked after her, she burst into tears.

Going into hell:

A hospital like Tsu-chi has won a great deal of approbation from many people who identify with its ideals. Doctors, nurses, volunteers, and staff, no matter whether they are Buddhist believers or not, indeed regardless of whether they have any religious beliefs at all, all strive to have their own heart the same as the Buddha's heart.

In front of the service desk, there is someone asking how to register and what department to register for; a volunteer is explaining the procedures in a friendly way. In the waiting room, nursing personnel take advantage of the waiting time to teach the ill and their families basic personal hygiene and health information, while volunteers also take this chance to give them massages and exercise their bones and muscles. At the emergency room and at the door of the Intensive Care Unit, volunteers busily try to ease the fears of nervous families.

"Hospitals are a hell on earth," says Su Jui-tang, who has taken three days off from his job to work as a volunteer at Tsu-chi. He does not "work" in the hospital but rather is "cultivating." He says that in just a few short hours, he has already been able to understand the logic taught by Master Cheng Yen: "know good fortune, treasure good fortune, and create good fortune for others."

Tsu-chi has more than l,000 volunteers like Su who come from all over the island. Each day, 40-50 serve in the hospital. In this "hell on earth" they come to understand the significance of life, and also bring some warmth to the hospital.

Seven years have passed like a day. Volunteer Yen Hui-mei "cultivates" each day in the hospital, and she even spends New Year's in the hospital with the patients.

The $10 million man:

As for doctors, nurses and other specialists, although Hualien is a remote place and turnover is high, many stay because they identify with the ideals of the hospital. These doctors feel that you couldn't ask for more from the work environment than you get at Tsu-chi.

Chen Ying-ho finished up a five-year residency training program at National Taiwan University Hospital in Taipei eight years ago, which happened to be the time Tsu-chi was being built, and he accepted a commission to come to assist. As a Christian, he originally had planned to serve two years there and then return to NTU; he never expected that he would fall in love with the atmosphere at Tsu-chi and stay.

When you talk about Chen Ying-ho, virtually everyone has heard the story of the 5 million dollar sniff. It is said that there was a cancer patient not long for this world who wanted to donate NT$5 million to Tsu-chi General Hospital, but was afraid they might not put it to good use and so travelled all the way from Taipei to Tsu-chi in Hualien for a secret visit. After looking over every part of the hospital, this individual happened to see a doctor on his rounds lift up a patient's foot and smell it. He was deeply moved by this, and raised his donation to NT$10 million.

This incident is oft-told within the hospital, and the doctor who unintentionally earned NT$10,000,000 for the hospital was none other than Chen Ying-ho.

Dr. Chen states that before doing surgery to repair a bone, it is necessary to confirm that the limb is already cleaned, and his method of confirmation is to use his nose-if he can smell the body this means it is already clean; if there is a bad odor this indicates that there are still bacteria. He never expected that this action would attract such a large charitable contribution.

At-home care is another service of the Tsu-chi Hospital.

Physical illness can be healed but minds are harder to cure:

Nevertheless, because Tsu-chi is a Buddhist hospital, people have more profound hopes and higher expectations. Some expectations are not even reasonable, such as that the skill of the doctors should be greater, that the medical personnel should be friendlier, that medication should cost less, or even, as some people believe, it shouldn't accept payment at all.

The high expectations that patients have of the medical personnel creates tremendous pressure on Tsu-chi doctors and nurses. But people consider that su-chi is a charitable institution so that they have the erroneous conception that it does not take payment, which creates an extraordinarily large backlog of unpaid debts at the hospital each year such as other hospitals rarely see.

Wu Jen-chiao, head of the Department of Medicine, indicates that some patients only say they have no money when they are about to be discharged and request payment in installments. The actual rate of collection for those who say they will pay by installment is extremely low. According to the calculations of Director Tseng Wen-pin, 65% provide only the first payment and then there is never the second one. There are even some patients who simply take off without notice after they are cured. There were more than 10 cases in January of 1993 alone.

As for those who are not really poor but simply want to avoid paying their bills, other hospitals mostly resort to legal channels to resolve the problem. But since its opening up to the present Tsu-chi has never taken a patient to court. This is because the Master says that this is a problem of conscience, and law can not resolve problems of conscience.

For a while the Medical Department employed the method of "summing up the bill once a week, and requiring payment in cash for future treatment if the previous bill has not been settled." They hoped in this way to reduce the unpaid bills. However, not long after its implementation, it was banned by the Master. She says: "How could you ever make it so that patients would not get their shots or couldn't take their medication?" "The Master often says that it's better to save someone who doesn't deserve it and not permissible to lose someone who could be saved," says Lin Chuan-hsia of the Office of Religion.

Tsu-chi Merit Committee members often go back to Tsu-chi for a look around this hospital built by concentrated love and expectations.

Save one too many rather than lose one too many:

Nevertheless, this devotion is misused by some people.

Recently, a young patient died at Tsu-chi. Not only did his parents have an unpaid account of more than NT$2 million, by the end they didn't even come to see their child and simply left the child to be cared for by hospital volunteers. Tung Hsu-chin says solemnly that the hospital is not a long-term care facility and patients should be cared for by their families and not left to the volunteers to look after. Because of Tsu-chi's fine reputation, many people see it as a charitable institution. They abandon responsibilities they should accept for themselves, which creates a waste of hospital resources.

Hsu Hsiang-ming also argues that the original idea behind its establishment was beneficial--to use resources to help those people who need help. Therefore, it's really a shame that greedy individuals also have their face in the trough.

Fortunately, the Tsu-chi Hospital has the support of the Tsu-chi Merit Association behind it. Each time they wish to build a new building or buy expensive instruments, they have no worries about the source of the capital. Moreover, routine expenses, like personnel and administrative costs, achieved a balance of accounts by the 6th year of operation. Tseng Wen-pin states that up to the present the operations at Tsu-chi have not been affected by the unpaid bills. But in the future it will be necessary to gradually develop a system and to map out appropriate conditions so that only those who meet those conditions can use the installment payment method. Only this way can the hospital soundly continue its work.

This is a problem of conscience:

Lai Yu-chia believes that with Tsu-chi having the Merit Association as its support and saving the poor as its goal, it can afford not to consider profit and loss on collection, medication and equipment, and can completely weigh the interests of the patients. "Nevertheless, this is a very special hospital method, and is not the norm for a typical hospital. It wouldn't be at all fair to require other hospitals to work this way," concludes Lai. Hospitals which run a loss over a long period simply cannot continue to operate.

Tsu-chi is a very special hospital model. Right now it is still seeking a path that will allow it to combine the ideals behind the establishment of the hospital with the ability to continue on in existence. The future is still uncertain but you can be sure of one thing--this hospital which has been built on the cumulative efforts of so many people will rely on the actions of many people for its future.

It is just as Master Cheng Yen says: "This is a problem of conscience."