Health care utilization among the Veteran in Taiwan

• Main Authors: Chao-Hsun Yang, 楊昭恂
• Other Authors: Sing-Chew Tam
• Format: Others
• Language: zh-TW
• Published: 2005
• Online Access: http://ndltd.ncl.edu.tw/handle/39996758216150786869

碩士 === 國立陽明大學 === 醫務管理研究所 === 93 === Abstract Objective： The objectives of this study are three-folds. One is to describe the health care utilization status for the veteran population under the National Health Insurance（NHI）in Taiwan and its variations caused by the differences in age, sex, beneficiary category and geographical location of the insured. Another is to discuss the effects imposed upon the veteran’s health care utilization by factors including the characteristics of the patients and the attributes of diseases. The other is to compare the difference between veteran and non-veteran’s choices of medical care institutions and the difference between Veterans and non-Veterans Hospitals’ service rate. Method： A two-part regression model and A secondary data set were used to analyze the factors that affect the veteran population’s health care utilization in Taiwan. Based on the NHI file provided by the National Health Research Institute, a total of 178,034 living enrollees in 2002 were retrieved as the study subjects. Results： In 2002, 93.6% of the veteran population utilized health care with an average number of outpatient visits of 25.3±23.8, hospital admissions of 1.6±1.2, and length of stay of 15.2±29.3 days per veteran per year. An age-matched control mechanism with a non-veteran to veteran ratio of 4, control variables, and a two-part regression model were used to yield the following findings: （1）In comparison to the non-veteran population, the veteran population had higher health care utilization, with an odds ratio of 1.64. In addition, the veteran population had 1.69 more outpatient visits, 0.35 fewer hospital admissions, 6.41 fewer hospital bed days, and an average of NT$10,386 lower medical expense. （2）Veteran, female, those aged between 70 and 79 and above 80 were found to have significantly higher outpatient utilization. Furthermore, the categories of 2, 5, 6 beneficiaries, the insured covered by Central Branch, by Southern Branch , by Kao-Ping Branch, and by Eastern Branch of BNHI, aborigines, those with major illness/injury, those physically or mentally disabled, and those with chronic conditions also had significantly higher outpatient utilization. （3）By contrast, a remarkably higher inpatient utilization was found among the populations of non-veteran, male, the categories of 5, and 6 beneficiaries, the insured covered by Eastern Branch of BNHI, aborigines, those with major illness/injury and those with chronic conditions. （4）Conspicuously higher medical expenses were observed among the populations of non-veteran, those above 80 years of age, the category 6 beneficiaries, aborigines, those with major illness/injury and those with chronic conditions. From the analysis of the 178,034 study subjects, large difference in the choice of medical care institutions is shown to exist between veteran and non-veteran populations. They were: （1）In comparison with the non-veteran population, the veteran population was more likely to choose Veterans Hospitals for outpatient utilization, approximately 20.4% of the veteran populations opting for the Veterans Hospitals for outpatient utilization. （2）In comparison with the non-veteran population, the veteran population was more likely to choose Veterans Hospitals for inpatient utilization, approximately 31.4% of the veteran populations opting for the Veterans Hospitals for inpatient utilization. （3）In comparison with the non-veteran population, the veteran population was more likely to choose Academic Medical Centers for outpatient utilization. （4） The choices of Academic Medical Centers for inpatient utilization showed no differences between veteran and non-veteran populations. （5）Both veteran and non-veteran populations visited the Physician Clinics the most frequently. Finally, in comparison with the non-Veterans Hospitals, the Veterans Hospitals had higher service rate of the veteran populations. There were approximately 32.0% of outpatient service and approximately 17.7% of inpatient service going to the veteran populations in the Veterans Hospitals. Conclusion： On average for the veteran populations, there were more outpatient visits, less hospital admissions, fewer hospital bed days and fewer medical expenses compared with their non-veteran counterpart per person per year in 2002. Besides, factors such as patient characteristics and the attributes of diseases had significant impacts on the veteran population’s health care utilization.