The effectiveness of Adult Preventive Care Service under National Health Insurance on early disease treatment and reduction of all-cause mortality

• Main Authors: Cheng-Chang Lin, 林承昌
• Other Authors: Chie,Wei Chu
• Format: Others
• Language: en_US
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/26966652913389041997

碩士 === 國立臺灣大學 === 預防醫學研究所 === 97 === Introduction：Chronic diseases prevention became more important in the first decades of the 20th century, which stimulated the implementation of screening programs. The National Health Insurance (NHI) reimbursed the adult preventive care service package for beneficiaries aged 40 and older in Taiwan since 1996. About one-third of its target population utilized this service periodically. However, there has been little evidence for the effectiveness of the service, particular in clinical outcomes. Purpose：The purpose of this study is to assess effectiveness of the adult preventive service on early treatment of chronic disease and the reduction of mortality. Material and methods：A total of 32,039 subjects aged 40-100 years by the year 2000 were identified from the representative 200,000-person sample in the reimbursement database of the National Health Insurance in Taiwan. Uptakes of preventive service during 1998-2000 were retrieved, and subjects were followed from Jan 1, 2001 to Dec 31, 2007, information about ambulatory visits and inpatient care during this period was also collected. Multiple logistic regression and Cox proportional hazard regression were applied to estimate the odds ratio and hazard ratio on newly treated hypertension, diabetes, hyperlipidemia and all-cause mortality for those who ever utilize the service. Extended Cox model with counting process was implemented to treat the time-dependent covariate and assess the effectiveness of each uptake. Results：There were 16,080 male (50.2%) and 15,959 female(49.8%) in the study population and the average age of each group were 55.6±11.9 years and 56.0±11.9 years. During the seven years follow-up, 32.1%, 9.1% and 14.5% of each defined cohort developed newly treated hypertension, diabetes and hyperlipidemia. The hazard ratios (HR) of each uptake on newly treated hypertension within one year were 1.80(95% confidence interval, CI: 1.64-1.97), 1.67(95%CI: 1.50-1.85) and 1.56 (95%CI: 1.43-1.72) among subjects aged 40-54, 55-64 and 65-100. For newly treated diabetes, the hazard ratios were 1.59(95%CI: 1.19-2.13), 2.21(95%CI: 1.87-2.61) and 1.76(95%CI: 1.50-2.05) among subjects aged 40-54, 55-64 and 65-100. For newly treated hyperlipidemia, the hazard ratios were 3.97(95%CI: 3.59-4.38), 3.21(2.85-3.63) and 2.82(95%CI: 2.49-3.20) among subjects aged 40-54, 55-64 and 65-100. All of these estimates were statistically significant (p< 0.001). The hazard ratio of each uptake on all-cause mortality within one and within seven years were statistically significant only among subjects aged 65-100 (HR: 0.74, 95%CI: 0.67-0.84; HR: 0.80, 95% CI: 0.72-0.89, p<0.001). Conclusion：This study provides strong evidence for impact of adult preventive care service on major health outcomes. The results indicated the effectiveness of the service on early treatment of hypertension, diabetes and hyperlipidemia, and finally, reduction of all-cause mortality, especially in subjects aged 65-100.