Investigating unmet health care needs under the National Health Insurance program in Taiwan: A latent class analysis

Abstract

Summary Objectives In Taiwan, although the implementation of the National Health Insurance (NHI) program reduced financial barriers and enhanced accessibility for individuals to utilize health care services, an unequal distribution of medical care resources still exists. This paper is focusing on analyzing factors that are associated with unmet health care needs among the middle‐aged and elderly under the NHI in Taiwan. Methods Statistical analysis from the 2007 Survey of Health and Living Status of the Elderly in Taiwan. We firstly adopted latent class analysis to classify individuals' observable reasons for feeling unwell but not seeing a doctor within the last 3 months into three latent perceived barriers classes. We further used a multinomial probit regression model to analyze factors that are associated with each perceived barrier class to the access of health care service. Results Results indicate relative to the “relatively no barriers” class, individuals with a high level of educational attainment tend to more likely to be in the “accommodation barriers” class, and individuals live in the most developed areas with the densest medical facilities tend to less likely to be in the “accessibility barriers” class. Conclusions We identified possible risk factors for each perceived barrier, which could provide important insights for health authorities and medical providers when targeting policies and interventions to efficiently assist people in need.

Characteristics Associated With Financial or Non-financial Barriers to Healthcare in a Universal Health Insurance System: A Longitudinal Analysis of Korea Health Panel Survey Data

“…However, self-reported data have been recognised as very useful in analysis despite the lack of physicians' assessment data because individuals are often more aware of their healthcare needs even though they may not know the names of diseases and treatment methods as accurately as physicians; and because individuals can provide more precise responses as to why their healthcare needs were not met. Such self-reported data have been used in several studies on unmet healthcare needs in the USA (82,83), Canada (24,26), Europe (29,84,85), Asia (28,86), and Africa (87).…”

Urban-rural disparity in lower extremities amputation in patients with diabetes after nearly two decades of universal health Insurance in Taiwan

“…A recent Taiwanese study by Chen et al, examining the rural-urban differences in receiving guideline-recommended diabetes care and experiencing avoidable hospitalizations between 2000 and 2010 [27], showed that although the ruralurban disparity in receiving recommended diabetes care reduced over the study period, there were still significant gaps between rural and urban areas in avoidable hospitalizations for diabetes. Another local study by Tian et al also found that although Taiwan is a country with small land area and convenient transportation, only individuals living in more developed areas with adequate medical facilities are less likely to be affected by the barriers of accessibility [12]. These local studies tend to suggest that limited access to comprehensive diabetes care for DM patients in less developed areas in Taiwan, could to some extent, attribute to the urban-rural disparity in LEA prevalence observed in our study.…”

“…Children, elderly people, and non-working adults benefit most from the NHI coverage [11]. Over the past decades, local researchers in Taiwan found improvements in health care and outcomes of Taiwanese people, such as extended life expectancy, and improved accessibility to health care services at reasonable costs [11,12]. In addition, Taiwan's NHI has waived copayment of all medical costs for patients with a catastrophic illness certificate, and low-income households in Taiwan enjoy insurance premium fully subsidized by the government [13].…”

Multidimensional factors affecting care needs in daily living among community‐dwelling older adults: A structural equation modelling approach

“…A large body of research has provided a greater understanding of the factors that determine the needs of older adults. Care needs in old age are related to many factors, and these include socio‐demographic factors such as age, sex, living situation, level of education, working status, mental health, household membership, care insurance, social support and family support (Gilmour, 2018; Hoi et al., 2011; Kong et al., 2014; Tian, 2018). Even though previous regression studies have found many factors that could influence the care needs of the elderly, the causal relationships between these factors are still unclear.…”