An Evaluation of the National Health Insurance Improvement Plan in Areas with Insufficient Western Medicine Resources on Medical Utilization

• Main Authors: Liang-Wei Chen, 陳亮維
• Other Authors: Yiing-Jenq Chou
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/91088858425550998614

碩士 === 國立陽明大學 === 公共衛生研究所 === 103 === Objective： 　The Taiwan National Health Insurance was implemented on March 1, 1995. Since then its coverage rate had reached 99.9% and has been shown to reduce barriers for medical care access. The government has also implemented many improvement plans to better facilitate medical access in mountainous areas, offshore islands and remote areas. This study explores the outcome of an improvement plan commenced on January 2002, which aimed at increasing western medicine outpatient usage for local residents in areas lacking medical resources. Specifically, this study aims to analyze the pattern of western medicine outpatient utilization for non-chronic and chronic diseases among local residents in these areas. Method： 　The study subjects included those who had ever used the improvement plan from 2002 to 2004 in the LHID2005 dataset, and excluded those who were born or died during the study period. A final sample of 20,384 people were included. Descriptive statistics were used to analyze the pattern of annual western medicine outpatient utilization for non-chronic and chronic disease. Multiple regression were used to analyze factors associated with such utilization in 2005. Result： 　The improvement plan increased usage of western medicine outpatient for non-chronic diseases from 12.33 to 13.14 visits per year as a whole, among which utilization decreased from 12.22 to 10.59 visits per year in areas with sufficient medical resource. In areas with insufficient western medicine resources, utilization increased from 0.41 visits to 2.55 visits per year. For chronic disease, utilization increased from 2.49 visits to 3.67 visits per year as a whole. In areas with sufficient medical resources, utilization increased from 2.49 visits to 3.32 visits, where as in areas with insufficient western medicine resources, utilization increased from 0.07 to 0.34 visits per year. Factors associated with higher western medicine outpatient utilization for non-chronic diseases include old age, low-income and catastrophic illness status. This pattern is less significant for chronic conditions. Conclusion： 　The improvement plan has enhanced medical accessibility for local residents, especially for people with non-chronic disease. This improvement plan has some impacts on the substitution of utilization between areas with and without insufficient western medicine resources. This effect is more visible for non-chronic diseases and for people in social vulnerable groups. More efforts should be put on improving utilization for chronic disease in the future.