Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan

Lin, Yen Ju; Tian, Wei Hua; Chen, Chun-Chih

doi:10.1016/j.healthpol.2011.08.007

Cited by 57 publications

(46 citation statements)

References 37 publications

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“…The first class is patients’ characteristics including sex, age, and income. For example, in a study about the National Health Insurance in Taiwan, patients who had lower educational attainment and income levels were less likely to use outpatient services [12]. The second class is environmental or external factors including medical insurance level and how health services are organized and delivered.…”

Section: Introductionmentioning

confidence: 99%

Effects of changes in health insurance reimbursement level on outpatient service utilization of rural diabetics: evidence from Jiangsu Province, China

Zhang

Wang

Qian

et al. 2014

BMC Health Serv Res

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BackgroundOutpatient reimbursement levels of the New Rural Cooperative Medical Scheme have changed in recent years in China, and those changes may have a greater impact on patients with chronic diseases due to their higher outpatient expenses. This study represents the first attempt to identify the effects of reimbursement level on outpatient service utilization for chronic patients in rural China and it also gives strong estimation results by conducting a tracer illness study in order to control for possible biases associated with studying several diseases together.MethodsThis study used difference-in-differences models to examine how changes in yearly maximum reimbursement amount and outpatient reimbursement rates affected rural residents with type 2 diabetes in three counties in Jiangsu Province, China. Other factors, such as sex, age and severity of illness, were also included in the model estimations. To make sure the treated group and control group are comparable, Propensity Score Match (PSM) was used to analysis the gender, age and severity of illness of the two groups.ResultsThe results indicate that an increase in yearly maximum reimbursement amount for outpatient visits could cause an increase in yearly total outpatient expenses for patients with type 2 diabetes mellitus. However, changes in outpatient reimbursement rates between 2010 and 2011 did not significantly affect the utilization of different types of health institution.ConclusionsThe reimbursement rates of village clinics should be substantially increased from the existing basis and the gap of reimbursement rates among different institutions should be further widened. It is also important for village clinics to improve their services. Moreover, measures to improve the quality of care and scope of services at lower-level healthcare institutions, and promote the health service utilization of rural women should be considered.

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Section: Introductionmentioning

confidence: 99%

Effects of changes in health insurance reimbursement level on outpatient service utilization of rural diabetics: evidence from Jiangsu Province, China

Zhang

Wang

Qian

et al. 2014

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Researchers have also reported differences in outpatient use in Taiwan among people living in areas with different levels of urbanization. This may be due to per capital shortages of hospital beds, physicians, nurses, and specialists, as well as the distances or time required to travel between a patient's residence and the closest service provider . These findings based on the Anderson model suggest that, under the National Health Insurance in Taiwan, those who were in a greater need for medical assistance were more likely to seek help.…”

Section: Discussionmentioning

confidence: 95%

“…This may be due to per capital shortages of hospital beds, physicians, nurses, and specialists, as well as the distances or time required to travel between a patient's residence and the closest service provider. 18 These findings based on the Anderson model suggest that, under the National Health Insurance in Taiwan, those who were in a greater need for medical assistance were more likely to seek help. No significant disparities were observed across different demographic or socioeconomic subpopulations.…”

Section: Discussionmentioning

confidence: 97%

“…The enabling factors included monthly household income, urbanization level of the residential area, disability, and comorbid conditions. Degrees of urbanization of the current residential area were categorized into three levels—urban, suburban, and rural areas—adopted from the proposed composite score by Liu et al which several studies have applied . Disability was measured using six items of activities of daily living (ADL) and eight items of instrumental activities of daily living (IADL).…”

Section: Methodsmentioning

confidence: 99%

“…Degrees of urbanization of the current residential area were categorized into three levels-urban, suburban, and rural areas-adopted from the proposed composite score by Liu et al 17 which several studies have applied. 13,18 Disability was measured using six items of activities of daily living (ADL) and eight items of instrumental activities of daily living (IADL). Disabilities were categorized into three levels as no disability, IADL disability only (having an inability for at least one IADL item, but no ADL disability), and ADL disability (having inability for at least one ADL item).…”

Section: Variable Of Interestmentioning

confidence: 99%

See 2 more Smart Citations

Fecal incontinence epidemiology and help seeking among older people in Taiwan

Horng¹,

Chou²,

Huang

et al. 2013

Neurourology and Urodynamics

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Health‐care utilization among dementia patients with or without comorbid depression in Taiwan: A nationwide population‐based longitudinal study

Liu

Wang

et al. 2023

Int J Geriat Psychiatry

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Background Few studies have examined the association of comorbid depression with health‐care utilization among dementia patients. This study compared health‐care utilization between dementia patients with and without comorbid depression. Methods Using Taiwan's National Health Insurance Research Database, we identified 10,710 patients with newly diagnosed dementia between 2005 and 2014: 1785 had comorbid depression (group 1) and 8925 did not (group 2). Patients were tracked for 1 year to evaluate outpatient, emergency, and inpatient service utilization and length of hospital stay (LOS). Multivariable regression was applied to examine the association between comorbid depression and health‐care utilization and analyze factors associated with inpatient visits and LOS. Results Group 1 had significantly fewer outpatient visits (β = −0.115; p < 0.001), more inpatient visits (β = 0.157; p = 0.005), and a longer LOS (β = 0.191; p < 0.001) than did group 2. The groups did not differ significantly in emergency visits (β = 0.030; p = 0.537). In group 1, age, gender, and specific comorbidities were predictors of inpatient visits; those factors and salary‐based insurance premiums were predictors of LOS. Conclusion Group 1 utilized less outpatient care but more inpatient care, suggesting health‐care service for these patients may be needed to improvement.

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Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan

Cited by 57 publications

References 37 publications

Effects of changes in health insurance reimbursement level on outpatient service utilization of rural diabetics: evidence from Jiangsu Province, China

Effects of changes in health insurance reimbursement level on outpatient service utilization of rural diabetics: evidence from Jiangsu Province, China

Fecal incontinence epidemiology and help seeking among older people in Taiwan

Health‐care utilization among dementia patients with or without comorbid depression in Taiwan: A nationwide population‐based longitudinal study

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