Top PDF The effect of Taiwan's National Health Insurance on infants' preventive care use and inpatient care use

2.4.2. NHI Taiwan’s NHI provides comprehensive curative health care for all children regardless of their financial position. It covers outpatient care, inpatient care, 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 inpatient care use. There- fore, we hypothesized that after the NHI was imple- mented, infants in Taiwan are more likely to have a greater demand for inpatient care use.

Abstract OBJECTIVE: To test whether utilization of infant preventive care services has reduced utilization of inpatient care and to determine whether implementation of Taiwan's National Health Insurance (NHI) has brought about any differences in the utilization of infant health care 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:

5. Conclusion Taiwan has implemented the National Health Insurance since 1995. Under the universal coverage, however, disparities in the use of preventive health care 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 and health system variables in evaluating disparities in receipt of preventive care. Limited medical resource on preventive care 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 health and 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 and use. Since the authorities have partially launched the System of Family Physician reimbursed by capitation in the selected clinics or hospitals (Department of Health, 2011), the disability-specific scheme of capitation reimbursement by age and by severity might be also considered in the timely pursuit of an extensive use of preventive health 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. The use of the claims data set allows us to measure the presence of seven different dia- betic complications or comorbidities defined by Newton and her colleagues [18], 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 of the 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.

health care utilization. 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 of the FDICP program was evaluated by comparing the utilization of prevention services, medical care services, and health care expenditures between these two groups.

Experimental and theoretical study of the 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.%) of the 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 ) of the conjugated polymers was found to be well correlated to the initial solution concentration (x 1,0 ) and the 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 the effect of the accelerative period on the 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 of the 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 of the National Health Insurance in 1995 in Taiwan, about 50% of the popula- tion was insured under the Civil Servant Insurance, Labor Insurance, and Farmer’s Health Insurance. 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’s Insurance, Laborer Insurance, or Farmer’s Health Insurance. 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. On the basis of the 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 on the Choshui River, we estimate (by using the postearthquake suspended-sediment rating curve) that 67% (up from 43%) of the 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 the health care provider as a quantity setter; see the column under “Nonretradability” in Table 1. Health care 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 and the patient’s response. Also, like the persuasion mechanism, the quantity setting model does not involve any other input into health care production.

This reasoning was behind my statement that independent repli- cation of the 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.

Background: 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 and the 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), and the high frequency of changing physicians and health care facilities. In this context, the issue of frequent

摘要: Taiwan's health-care system allows patients to utilize specialty services without referrals by primary care providers. This discontinuity of care may lead to increases in future hospitalizations. This study aims to determine whether the discontinuity of care 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 摘要 Abstract BACKGROUND: Few studies were found that evaluated dissatisfaction with the National Health Insurance (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

CONCLUSIONS: These results can provide valuable information to help policy makers identify areas for improvement and intervention in order to reduce levels of dissatisfaction of primar[r]

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 the National 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 health and 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 of the 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 of the 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.

Abstract 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 Taiwan National Health Insurance. However, the burden of health care costs means structure, the burden of health insurance premiums Although the proportion jumped to 50 percent or more, but privately some are still highest in the 35%

One of major questions the NH1 planning task force had to address was ‘Can Taiwan afford a NHI?’ There were concerns about the rapidly rising health care costs[r]