| Summary: | 碩士 === 國立成功大學 === 公共衛生研究所 === 96 === Background: To promote the quality of diabetes care, the National Health Insurance of Taiwan (NHI) initiated the shared care model of quality-based payment program for diabetes shared care in November, 2001. Nevertheless, studies revealed great variations in participation rates among physicians and patients.
Objectives: First, to examine if there were social inequalities in participation rates among diabetic patients. Second, to contrast the patterns of social inequalities in participation rates by regions with different policies in promoting the participation.
Methods: The claims data of the year 2005 were obtained from the Central Region Branch, Bureau of National Health Insurance (BNHI). Two individual level (i.e., level of premium and occupation category) and one contextual level (i.e., level of urbanization of residence place) of measures of socioeconomic position (SEP) were used. The liner regressions slopes and odds ratios were used to indicate the gradient of social inequalities of participation rates. Control variables included characteristics of patients, physicians, clinics and hospitals. We further compared the patterns of social inequalities between Taichung city and county with different policies in promoting the program.
Results: Individual level indicators revealed that diabetic patients with higher premium and occupational category had higher participation rates (a positive association). On the contrary, contextual level indicator showed that diabetic patients live in places with lower level of urbanization had higher participation rates (a negative association). Taichung country, with policy focused on local clinics, had negative association between level of urbanization with participation rates. On the other hand, Taichung city, with policy focused on hospitals and medical centers, had positive association between levels of urbanization with participation rates.
Conclusions: Different indicators of SEP might result in different patterns of social inequalities in participation rates. Through effective promoting policies diabetic patients live in lower level of urbanization areas could still have higher participation rates for quality-based payment program. This study concluded that interventions could reduce the social inequalities in participating effective diabetic care programs.
|
|---|
