The distortions of care needs and medical professionalism: The ruling practices of migrant labor policy in Taiwan

• Employment of live-in migrant care workers in Taiwan requires the state’s approval.
• Since 2000 the Taiwanese government has required medical practitioners to use the Barthel Index for medical assessment of care needs.
• Physicians have become part of the ruling practices of migrant labour policy.
• I discover how policy subordinates people’s interests to the governmental purpose.

According to Taiwanese government policies and regulations, families planning to hire migrant care workers must apply for a medical assessment of the needs of elderly people destined to be cared for. The physician conducting this assessment acts as a gatekeeper who carries out her/his work with state and medical profession authority to identify, define, and regulate older people's needs. Using institutional ethnography as the method of inquiry, this article locates the problematic nature of the medical assessment as an entry point to an inquiry into how the care needs met by migrant workers are textually-mediated. This article begins by telling the daily story of an old woman and her live-in migrant worker to point out the standpoint of care recipients and their families where the inquiry anchors. I examine the physicians' daily working activities of medical assessment to discover how policy subordinates people's interests to the governmental purpose.