The impact of health inequalities by the medical service subsidy plan for children below three years old

碩士 === 國立成功大學 === 公共衛生研究所 === 100 === Objectives: This study mainly focused on the implementation of “the medical service subsidy plan for children below three years old”. We analyzed the medical utilization pattern of all-cause disease and asthma for children who were under the different urbanizati...

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Bibliographic Details
Main Authors: Yi-TingChen, 陳怡婷
Other Authors: Liang-Yi Wang
Format: Others
Language:zh-TW
Published: 2012
Online Access:http://ndltd.ncl.edu.tw/handle/82936253643925115346
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Summary:碩士 === 國立成功大學 === 公共衛生研究所 === 100 === Objectives: This study mainly focused on the implementation of “the medical service subsidy plan for children below three years old”. We analyzed the medical utilization pattern of all-cause disease and asthma for children who were under the different urbanization and at different socio-economic status to investigate the tendency of the subsidy programs to equality. Methods: Data source form the National Health Insurance from National Health Research Institute. We observe the children cohort who were born on 1994 Jun 1st - 2007 Dec 31, and linked their medical record before the age of three. Furthermore, children are divided into five socioeconomic status groups (high, middle, low-income group, local population group and law defined the low-income household group). After controlled by age, gender, and insurance area, ANOVA, negative binomial regression and chi-square test were applied to examine whether there were discrepancies in the health care utilization and health status for the children from different socioeconomic status groups. Results: On the all-cause medical use of children in the different urbanization, we found that the outpatient visits in urban areas came closer to the other urbanized areas after the implementation of the plan on March 1, 2002. However, the number of hospitalizations difference between those two areas was not significantly changed. Stratified by socio-economic status, there was no difference between the three income groups in outpatient visits while law defined low-income households and local population groups showed that the low outpatient visits with no significantly changed even after the introduction of the plan. The hospitalization of low-income households group in law showed a trend which was higher than of the other four groups significantly. The asthma prevalence increased from 1.96% (birth in 1996) to 5.43% (birth in 2004), while the high-income group obtained the highest asthma prevalence. There was no statistic significant between different socio-economic statuses in asthma outpatient counts for children who had asthma; however, the asthma caused hospitalization of low-income group was significantly higher than other groups, and even after the plan implementation. In addition, the use of well-baby clinic revealed the lowest resource usage in the law defined low-income group whereas non-well-baby clinic usage showed the lowest counts in the local population group. Conclusions: The policy “the medical service subsidy plan for children below three years old” did not significantly shrink the discrepancies of the socio-economic status in outpatient and inpatient. This study found that all-cause outpatient or asthma outpatient in the local population group, are significantly lower than it is in other socio-economic status. The local population group’s children may also belong to the economically disadvantaged, so their medical usage doesn’t been impacted by the project. Relatively, the counts of hospitalization owing to asthma and owing to all cause are both generally high in low income group. The possible reasons accounts for this phenomenon are- the resources are over used for hospitalization , and more likely, they easily meet severe healthy problems therefore need to be hospitalized due to the inequality in health.