| Summary: | 碩士 === 中國醫藥大學 === 醫務管理學系碩士班 === 102 === Purposes: The need for long-term care (LTC) is escalating as aging population in Taiwan grows rapidly. The expected, increasing prevalence of chronic diseases unavoidably leads to the enormous consumption of emergency medical care resources. However, there is a dearth of comparison for emergency service utilization between institutional and home-based LTC users. This study aims to analyze the factors associated with the use of emergency service and, especially, the difference of emergency service utilization between institutional versus home-based LTC in Taiwan.
Methods: This study adopted the retrospective cohort design. Longitudinal, secondary data analysis was conducted by utilizing the data extracted from 1,000,000 randomly sampled beneficiaries recorded in the 2002-2011 Taiwan National Health Insurance Research Database. 1,675 institutional and 6,757 home-based LTC users were identified and then matched with the same numbers of control group of identical gender and age. Analysis methods included Chi-square test, McNemar’s test, binomial logistic regression, and General Linear Model (GLM) performed in SAS 9.2.
Results: The average times of emergency service use among institutional residents were 9.43±8.04 and average expenditures for emergency service were NT$1496.8±2837.2. The average times of emergency service use among home-based LTC users were 10.15±9.96 and average expenditures for emergency service were NT$1499.5±2234.1. 95.46% of institutional residents used emergency services and 96.23% of home-based LTC users did. The associated factors of emergency service utilization among institutional and home-based LTC users included gender, age, premium, region, urbanization, severity of illness, and type of chronic disease. The results of matching indicated that the times of emergency service use among home-based LTC user were higher than those of institutional residents. There was no significant difference in the emergency service expenditures between the two types of LTC. Compared to institutional residents, the odds of emergency service use among home-based LTC users was higher but not in the significant level.
Conclusion: A significant difference in the times of emergency service use between institutional and home-based LTC users was found. The authorities and LTC units should target the LTC users in the high risk of emergency service use and conduct the preventive interventions to reduce the utilization of emergency service.
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