Taiwan’s NHI provides comprehensive curative healthcare for all children regardless of their financial position. It covers outpatient care, inpatientcare, den- tal care, and prescription drugs. Although co-payments were adopted for healthcare use, the BNHI has also imposed ceilings on co-payments to prevent the pub- lic from incurring catastrophic expenses. In addition, if beneficiaries suffer a major illness or injury and require long-term and highly expensive treatment, they are exempted from any co-payment obligation. Since most infants were uninsured before the NHI, this gen- erous program seems to have dramatically decreased the financial burdens for medical expenditures and may have induced a demand for inpatientcareuse. There- fore, we hypothesized that after the NHI was imple- mented, infants in Taiwan are more likely to have a greater demand for inpatientcareuse.
OBJECTIVE: To test whether utilization of infant preventivecare services has reduced utilization ofinpatientcareand to determine whether implementation ofTaiwan'sNationalHealthInsurance (NHI) has brought about any differences in the utilization of infant healthcare services. DATA SOURCES: Data were taken from the 1989 and 1996 National Maternal and Infant Health Surveys (NMIHSs). In total, 1662 and 3623 effective samples were used in the study from the 2 years. STUDY DESIGN:
Taiwan has implemented theNationalHealthInsurance since 1995. Under the universal coverage, however, disparities in theuseofpreventivehealthcare among children with disability were still found by children and parental demographics, health status, type and severity of disability. Of all the associated factors, urbanization level is most evident. With much room for improving the utilization, older, poorer children with disability and older parents should be targeted. Future research would beneﬁt from ﬁnely adjusting for the reimbursement andhealth system variables in evaluating disparities in receipt ofpreventivecare. Limited medical resource onpreventivecare justiﬁes the necessity of its effective investment in especially those in need. The authorities should tackle the disparities using a strategic framework, which involves special healthand support needed assessments in culturally appropriate ways, a differential subsidy set for different severity of disability, redirecting medical resources to under served areas through mobile health services and incentives, and educating low income groups, to increase the accessibility anduse. Since the authorities have partially launched the System of Family Physician reimbursed by capitation in the selected clinics or hospitals (Department ofHealth, 2011), the disability-speciﬁc scheme of capitation reimbursement by age and by severity might be also considered in the timely pursuit of an extensive useofpreventivehealth services among children with disability.
severity of diabetes patients were also adjusted in the survival analysis model. The ﬁrst covariate is the number of compli- cations or comorbidities. Theuseofthe claims data set allows us to measure the presence of seven different dia- betic complications or comorbidities deﬁned by Newton and her colleagues , including cardiovascular disease, essential hypertension, foot/lower-extremity problems, peripheral vas- cular disease, cerebrovascular disease, renal disease and eye disease. We further generated a summation index for diabetic complications or comorbidities by adding up the total number of individual complications or comorbidities with an equal weight across all ambulatory visits during the time window where we calculated the UPC scores. The second covariate is the total number of visits for diabetes treatment per year. We assumed that the greater the number of visits per year might indicate more severity for a diabetic patient, therefore increasing the risk of hospitalizations. The third covariate is the type of practice setting ofthe patients’ usual provider, including medical centers, regional hospitals, district hospitals and primary care clinics. We assumed that the visit of different settings may be associated with different levels of complexity in their diabetes conditions. In this study, we focused on subjects who were newly diagnosed with diabetes.
Methods: We adopted the NHI claim data from 2004 to 2006. Patients who joined FDICP for consecutive three years were recruited as the intervention group and those who never joined as the comparison group. By adjusting the propensity score, we controlled the selection bias due to the demographic discrepancies. The effectiveness ofthe FDICP program was evaluated by comparing the utilization of prevention services, medical care services, andhealthcare expenditures between these two groups.
Experimental and theoretical study ofthe spin coating deposition of thin and ultrathin films from dilute solutions of four conjugated polymers, including poly[2-methoxy-5-(2V-ethylhexyloxy)-1,4-phenylenevinylene] (MEH-PPV), regioregular poly(3-hexylthiophene), poly(9,9-dioctylfluorenyl-2,7-yleneethynylene), and poly(2,2V-(3,3V-dioctyl-2,2V-bithienylene)-6,6V-bis(4-phenylquinoline)), is reported.
Dilute solutions (0.3–2.0 wt.%) ofthe four conjugated polymers in chloroform were found to be Newtonian fluids with viscosities of 0.7–27.9 cp. The measured film thickness (h f ) ofthe conjugated polymers was found to be well correlated to the initial solution concentration (x 1,0 ) andthe spin speed (x) by the simple expression, h f =k x 1,0 x h . The exponent b is 0.5 for MEH-PPV but is reduced to 0.4 for the other three conjugated polymers. The difference in the b values can be explained by theeffectofthe accelerative period onthe spin coating of less viscous dilute polymer solutions as verified by numerical simulation. A modified Meyerhofer’s model was also found to well correlate the film thickness with the fundamental physical properties ofthe polymers and solvent. These experimental and theoretical results provide a basis for understanding and optimizing the preparation of thin and ultrathin films of conjugated polymers by spin coating.
Prior to the implementation oftheNationalHealthInsurance in 1995 in Taiwan, about 50% ofthe popula- tion was insured under the Civil Servant Insurance, Labor Insurance, and Farmer’sHealthInsurance. At the time, pharmaceutical companies were allowed free pri- cing, and they were subject to hospitals’ pharmaceutical tender and negotiation to determine the price of drugs in hospitals. Hospitals would bill the insurers. The in- surers would then reimburse individual hospitals by an approach known as “transaction cost-plus”. For drug reimbursements, the joint bid price would be paid to public hospitals while to this price plus 10-20% would be paid to private hospitals. Profits were usually used to pay for drug warehouse management, dispensing and other expenses. High-level hospitals tended to use more expensive, brand-name drugs or imported drugs be- cause of profits from pharmaceutical sales. At the time of public bidding in public hospitals, manufacturers were reluctant to cut prices, resulting in high tender prices. Prescription drugs were paid out-of-pocket in primary care settings because most patients were not insured under the Government Employee’sInsurance, Laborer Insurance, or Farmer’sHealthInsurance. As a result, patients were sensitive to drug prices; many would choose domestic, generic drugs over the more expensive, brand-name drugs or imported drugs.
Elevated postseismic sediment delivery to the coast suggests that the offshore sedimentary record may contain information on locations and recurrence intervals of past earthquakes. Hyperpycnal flows are negatively buoyant fluvial discharges caused by high concentrations of suspended sediments. Onthe basis ofthe average temperature (23–28 8C) and salinity (34‰) of oceanic coastal waters around Taiwan, con- centrations of 36–39 g/L will produce hyperpycnal flow (Boggs et al., 1979; Mulder and Syvitski, 1995). From hydrometric observations at the lowermost station onthe Choshui River, we estimate (by using the postearthquake suspended-sediment rating curve) that 67% (up from 43%) ofthe 143 Mt·yr 2 1 annual suspended-sediment discharge from Choshui River following the Chi-Chi earthquake was delivered under conditions for which C s . 40 g/L. We infer that hyperpycnal plumes were formed on at least four occasions since the earthquake, each during the typhoon season. By using the background sediment- concentration rating curve, we estimate that only one storm would have produced a hyperpycnal plume had the earthquake not occurred. Our calculations suggest that earthquake-driven geomorphic processes may leave a record of mountain-building processes in foreland stratigraphy.
The second mechanism regards thehealthcare provider as a quantity setter; see the column under “Nonretradability” in Table 1. Healthcare providers supply a nonretradable service (Farley, 1986; Gaynor, 1994). A monopolistic competitor selling a nonretradable service sets a quantity to maximize profit. Recognition of physician quantity setting power stemming from nonretradability accords well with most patients’ experiences with physi- cians who, quite simply, “tell them what to do”. Of course, the theory must also recognize that consumers need not always comply with physicians’ instructions. Generally, one can interpret the quantity setting model as one in which quantity restrictions are placed by physi- cians, and patients respond to these restrictions. Empirically, this theory says that observed quantity results from the physician’s quantity restriction andthe patient’s response. Also, like the persuasion mechanism, the quantity setting model does not involve any other input into healthcare production.
This reasoning was behind my statement that independent repli- cation ofthe ﬁ ndings would be ideal.
I understand that such a trial might never happen owing to costs and logistical challenges, but one can at least suggest it. Again, I would like to congratulate the ResQ trialists for their substantial accomplishment and look forward for many high-quality clinical trials to come.
Since the medical system in Taiwan is more unique than that in other countries, people in Taiwan have more rights over choosing their own medical care
providers. Besides, with the immaturity of both the family physician system andthe referral system in Taiwan, this unique system is characterized by the large average number of outpatient visits, the high rate of hospital attendance (especially the medical center attendance), andthe high frequency of changing physicians andhealthcare facilities. In this context, the issue of frequent
摘要: Taiwan'shealth-care system allows patients to utilize specialty services without referrals by primary care providers. This discontinuity ofcare may lead to increases in future hospitalizations. This study aims to determine whether the discontinuity ofcare is associated with the risk of hospitalization.
ment under the NHI.
Traditionally, primary care physicians would stay in their own clinics as long as possible to avoid losing any potential patients. Lin in 1999 concluded that the average primary care physician in Taiwan works 9.36 hours per day and 6.20 days per week. (2) The long working hours led to a shortage of time for primary care physicians to attend continuing educa- tion programs. Moreover, according to a study by Mawardi, physicians may be dissatisfied with their limited medical knowledge or abilities, (11) since the pace of growth in medical technology was faster than expected during the past 2 decades. Thus, primary care physicians in Taiwan have to absorb updated medical knowledge to stay competitive with hospi- tal-based physicians in the healthcare market. In par- ticular, the increasingly complicated procedures of medical claims under the NHI require physicians to receive continuing education so they can remain competent. However, the lack of time for continuing education was not significantly related to the level of dissatisfaction under the NHI in this study. Further investigation is needed in the future to understand the relationship between continuing education and dissatisfaction.
Lin H-C.;Chang W-Y;Tung Y-C
BACKGROUND: Few studies were found that evaluated dissatisfaction with theNationalHealthInsurance (NHI) by primary care physicians in Taiwan. Therefore, the purpose of this study was to identify factors related to dissatisfaction with the NHI among primary care physicians. METHODS: A structured questionnaire was developed through a literature review, a panel discussion, and 5 focus group
ing. Second, although 95.8% of respondents were par- ents, information may be underreported if parents are not fully informed about their children’s visits to non- traditional settings, such as school-based health centers or teen clinics. Third, dental insurance coverage was parentally reported; parents may be unclear or inaccu- rate in their understanding of dental coverage. However, our estimate of uninsured children (22%) is somewhat close to the levels found in the 2002 theNational Survey of America’s Families (26%) 9 and in the 2001 California Health Interview Survey (23.6%). 18 Finally, the unmet need measure is subject to recognition and recall error, because it assumes that parents all recognize dental need and can recall this need at the interview time. Reporting bias would occur if parents think that the unmet need is a socially undesirable concept and are not willing to acknowledge this. Using standard questions that have been used elsewhere, our results on unmet need can be compared with previous findings. 6,8,29 The positive asso- ciation between perceived poor dental healthand unmet need indicates that the data has its own face validity despite potential limitations.
Data pro cess ing and sta tis ti cal anal y sis
The da ta base soft ware of Microsoft SQL Server 2000 was used for data link age and cal cu la tion. For the age- and sex-specific prev a lence, the de nom i na tors were those peo ple who were still in sured un der the NHI in 2000. Among the 50,000 peo ple ofthe sam pling co hort, 46,614 were still in sured in 2000. In cal cu lat ing the num - bers of DDDs per 1,000 in hab it ants per day for each kind of antilipemic drugs, the to tal num bers of DDDs from the co hort were at first di vided by 46,614 (peo ple in sured un der the NHI at the end of 2000) and 366 (days in year 2000), and then mul ti plied by 1,000 (in hab it ants). In cal - cu lat ing the SMR, the stan dard pop u la tion was also the co hort. The prev a lence rates and SMRs were dis played with 95% con fi dence in ter vals. 9
Background: The prevalence of overweight and obesity are growing progressively among the elderly (over 65 years). Underweight, even though it occurs in only a tiny fraction ofthe population, is actually
associated with more excess deaths. Overweight, obesity, or underweight are not healthy body weight, which are both important risk factors for severe diseases and disability in the elderly.
In order to ensure that all citizens have access to appropriate
medical care, get rid of because of lack of medical treatment caused by obstacles, the Republic of China 80 years from March 1, was officially launched in TaiwanNationalHealthInsurance. However, the burden ofhealthcare costs means structure, the burden ofhealthinsurance premiums Although the proportion jumped to 50 percent or more, but privately some are still highest in the 35%