A Study on Medical Services Utilization and Related Factors of Disadvantaged Minorities before and after the implementation of BNHI’s “Medi-Aid” Program

• Main Authors: Li-Yu Lu, 盧麗玉
• Other Authors: Ching-Wen Chien
• Format: Others
• Language: zh-TW
• Published: 2012
• Online Access: http://ndltd.ncl.edu.tw/handle/72261051974888710528

碩士 === 國立陽明大學 === 醫務管理研究所 === 100 === Background and objectives: Many studies show that vulnerable people with poorer health status have higher demand for medical care. However, locking National Health Insurance Card would serve as a measure that excludes those who have lower payment capacity but higher morbidity. In order to eliminate medical barriers for economically vulnerable groups, the National Health Insurance Bureau has separately dealt with overdue issue of insurance premium and medical care rights of the insured since Oct. 2010 - unlocking the card of qualified near-poor households under asset investigation immediately. There were around 36 thousand people whose card were unlocked in the 1st batch. The purpose of this study is to investigate the utilization of medical care, differences between low-income households, generally insured objects and related factors while comparing pre- with post- unlocking card period. Method: The research which samples in October 2010 concludes control and experimental groups. Combine the insured and medical profiles in the National Health Insurance Bureau to gain the utilization of medical care and the related information a year before and after unfreezing the card.In the data analysis, this study uses difference in differences (DID) analysis to calculate the fixed effects for pre- and post- unlocking card period which never change from time to time. Then generalized estimating equation (GEE) is used to analyze the impact of changes in the use of medical care after controlling the interference variables. Results: 1. Unlocking card will improve the medical care access of the economically vulnerable groups, but the improvement is limited. 2. Most are young and middle-age adults; nearly 70% of insured ones are reclassified as the sixth category.3. Dental and traditional Chinese medicine costs of women are higher than men while the hospitalization and overall costs show inversely.4. The medical use of those whose insured amount is less than 36,300 dollars has increased significantly; the utilization is higher as the insured amount of dental and traditional Chinese medicine is larger.5. Both frequencies of using traditional Chinese medicine and hospitalization days for those having chronic diseases are higher. The increase is fairly obvious, while hospitalization cost rise a little. The frequency of the traditional Chinese medicine use for those having chronic diseases rises significantly while the frequency of the seriously injured rises little.6. Fees generally rise more in five municipalities than in Taiwan Province, but the costs of hospitalization and the number of days in Taiwan Province rise more. The use of traditional Chinese medicine is higher in central and southern Taiwan than in northern; the dental use is higher in five municipalities than in Taiwan Province. 7. The use of all kinds of medical care of mountain aboriginal generally rises more, but the non-indigenous use more in dental and traditional Chinese medicine. Conclusion&; Recommendations::The card unlocked policy indeed improves medical care for the economically disadvantaged, while the rise is unobvious, which means the barriers may exist yet. Therefore, we raise some suggestions:1. Continuously offer the assistance via the implementation of “Medi-Aid” Program and understand the factors which may affect the usage of medical care as well as other supporting policies.2. Expand the hospitalization right of the disadvantaged by proceeding the concept of Poverty Belt.3. Increase the accessibility of dental health care and dental resources for people in remote mountain areas.4. Strengthen the disease care and health education to avoid chronic diseases being cared improperly or minor illness dragged into a serious illness, thus delaying opportunities of treatment.