Social Disparities in Health and Medical Care in Taiwan

• Main Authors: Jung-Hua Liu, 劉容華
• Other Authors: Tung-liang Chiang
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/18980786221522231887

博士 === 國立臺灣大學 === 衛生政策與管理研究所 === 94 === Background and Objectives: On March 1, 1995, the Taiwan government inaugurated a national health insurance to assure health care for all citizens and reduce disparities in health. This study applied a structure-process-outcome framework to examine the changing geographic disparities in health and medical care in Taiwan between 1986 and 2004, with an emphasis on the impact of the national health insurance scheme. In specific, the objectives of this study are: (1) to analyze the changing geographic distribution of physician manpower between 1986 and 2004, (2) to examine the changing geographic differences in medical services utilization between 1994 and 2004, and (3) to investigate the changing geographic variation of avoidable mortality between 1986 and 2004. Methods: The study period was from 1986 to 2004. Data for the analysis came from the annual national surveys of hospitals and clinics, the annual family income and expenditure survey, the 1994 and 2001 national health interview survey, the databases of death certificate, the annual demographic fact book, and the 1980 population and housing census. For the geographic disparities of physician manpower and avoidable mortality, we used area as the unit of analysis, including the level of city/county and the level of township. For medical services utilization, we applied a multilevel method by taking into account both individual and area levels. Statistical methods used included descriptive statistics, segmental regression, multilevel censored regression, and multilevel logistic regression. Results: Between 1986 and 2004, the total supply of physician manpower in Taiwan increased by 109% from 15,852 to 33,259, with the ratio of office-based physician to hospital physician decreasing from 0.87 to 0.60. By using the segmental regression analysis, we found that: (1) the supply of physician manpower was significantly associated with area socioeconomic development; and (2) after the implementation of the national health insurance, the geographic disparities of hospital physician manpower continuously decreased, in contrast to the widening geographic disparities of office-based physician manpower. The results from the national health interview survey showed that, the likelihood of any use for physician services, inpatient services, and emergency services was 37.2%, 8.0%, and 10.6%, respectively, in 2001, while the comparable figures for 1994 were 23.8%, 10.5%, and 9.3%. By using the multilevel censored regression and multilevel logistic regression analysis, we found that, although hospital admission was not significantly associated with area socioeconomic development, people living in deprived areas tended to use more physician services and were less likely to use emergency services. However, further stratification analyses by health insurance coverage, only use of emergency services for the insured in 2001was significantly associated with area socioeconomic development, after adjustment for individual socioeconomic position. Between 1986 and 2004, age-standardized all-cause mortality for aged 5-64 in Taiwan declined by 25% from 2.8‰ to 1.3‰. This was made up of a 34% fall in avoidable mortality and a 8% fall in non-avoidable mortality. By using the segmental regression, we found that: (1) avoidable mortality and non-avoidable mortality were significantly associated with area socioeconomic development; and (2) the geographic disparities of avoidable mortality increased at a slower pace, in contrast to the geographic disparities of non-avoidable mortality worsened more rapidly after the introduction of the national health insurance. This was especially significant for avoidable mortality associated with primary prevention. Conclusions: The implementation of the national health insurance is helpful for closing the gaps in health disparities in Taiwan. However, the national health insurance was not found to be associated with amelioration of geographic disparities of physician manpower and medical services utilization.