President Chen Shui-bian's team has been lurching from one crisis to another for much of its time in office, and it was ill-prepared to deal with the Sars challenge from the start.

The tools with which it has had to fight the virus are not inadequate, but it is clear that Taiwan's health-care system has been waiting for a big wind such as Sars to come along and blow it over.

Standards among medical practitioners are generally high, and have been kept so despite the island's exclusion from the World Health Organisation. Yet the inability of the system to respond quickly to the Sars crisis reflects weaknesses in its chain of command.

This has been a long time coming, and could even be traced to the late former president, Chiang Ching-kuo, lifting martial law in 1987. Just as every arm of the government has had to adjust itself to the new realities of democratic rule, so too has the health service.

The most crucial change took place, ironically, soon after Mr Chen became Taipei's first directly elected mayor in 1995. Although a member of the central government's cabinet, the Taipei mayor has the right to appoint his own senior officials - including his health chief. And because he is directly elected, he and his health chief will inevitably run their own agenda.

This served Mr Chen well as mayor. Most memorably, soon after moving into City Hall, he was able to offer free health care to all children under the age of six in Taipei.

As president, however, the degree of local autonomy afforded to Taipei has come back to haunt him as his chief political rival, Ma Ying-jeou of the KMT, is now mayor.

The system is hampered by more than political rivalry. As Taiwan has democratised, so health care has become a financial burden for the government. Hospitals have come under pressure to fund more of their own expenses, while the electorate has grown content with a National Health Insurance system established in 1995, which makes medicines nearly free.

So hospitals have been struggling to meet their bills for salaries and equipment by running pharmacies: they prescribe, the National Health Insurance Bureau pays. This basic conflict of interest has obviously undermined the efficient management of hospitals.

Compounding the problem has been corruption and vested interests, the hallmarks of many a fledgling democracy. Foreign medical equipment manufacturers complain constantly of regulations that appear designed to frustrate them, while the big multinational pharmaceutical companies are usually at their most vocal this time of year, complaining about their inability to get drugs licensed in Taiwan before patents run out.

What has become clear is that privatisation is not the cure to all ills afflicting the system. The Chang Gung Memorial Hospital in Kaohsiung, which is run by the mighty Formosa Plastics conglomerate, has seen a rush of staff resignations, too. Many are nurses who complain that they have been underappreciated - and underpaid - as lower-ranking workers for years.

Add all this up and it is hardly surprising that Taiwan has been struggling to contain the Sars outbreak. Faced with shortages of protective gear, frontline medical staff have let all their frustrations with the system boil over in the face of the Sars crisis.

It can all change for the better, however, if the people most affected by the Sars outbreak decide to do something about it. For if there is one lesson Taiwan's electorate should surely have learned amid this crisis, it is to expect more from their heath-care authorities.

If that means rewarding candidates who run in the next election on a detailed platform for reforming the system, then all the better. But whoever is in power, the Taiwanese are going to have to stop expecting good care at very low cost.