scholarly journals Low acuity paediatric emergency visits under single-payer universal health insurance in Taiwan, 2000–2015: a population-based repeated cross-sectional design

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e042084
Author(s):  
I-Anne Huang ◽  
Yiing-Jenq Chou ◽  
I-Jun Chou ◽  
Yu-Tung Huang ◽  
Jhen-Ling Huang ◽  
...  
Keyword(s):  
Health Insurance ◽  
Paediatric Population ◽  
Population Based ◽  
Universal Health Insurance ◽  
Cross Sectional ◽  
Single Payer ◽  
Insurance Programme ◽  
Ed Visits ◽  
Cross Sectional Design ◽  
Universal Health

ObjectivesEmergency services utilisation is a critical policy concern. The paediatric population is the main user of emergency department (ED) services, and the main contributor to low acuity (LA) ED visits. We aimed to describe the trends of ED and LA ED visits under a comprehensive, universal health insurance programme in Taiwan, and to explore factors associating with potentially unnecessary ED utilisation.Design and settingWe used a population-based, repeated cross-sectional design to analyse the full year of 2000, 2005, 2010 and 2015 National Health Insurance claims data individually for individuals aged 18 years and under.ParticipantsWe identified 5 538 197, 4 818 213, 4 401 677 and 3 841 174 children in 2000, 2005, 2010 and 2015, respectively.Primary and secondary outcome measuresWe adopted a diagnosis grouping system and severity classification system to define LA paediatric ED (PED) visits. Generalised estimating equation was applied to identify factors associated with LA PED visits.ResultsThe annual LA PED visits per 100 paediatric population decreased from 10.32 in 2000 to 9.04 in 2015 (12.40%). Infectious ears, nose and throat, dental and mouth diseases persistently ranked as the top reasons for LA visits (55.31% in 2000 vs 33.94% in 2015). Physical trauma-related LA PED visits increased most rapidly between 2000 and 2015 (0.91–2.56 visits per 100 population). The dose–response patterns were observed between the likelihood of incurring LA PED visit and either child’s age (OR 1.06–1.35 as age groups increase, p<0.0001) or family socioeconomic status (OR 1.02–1.21 as family income levels decrease, p<0.05).ConclusionDespite a comprehensive coverage of emergency care and low cost-sharing obligations under a single-payer universal health insurance programme in Taiwan, no significant increase in PED utilisation for LA conditions was observed between 2000 and 2015. Taiwan’s experience may serve as an important reference for countries considering healthcare system reforms.

scholarly journals Public policy for the poor? A randomised assessment of the Mexican universal health insurance programme

The Lancet ◽  
2009 ◽  
Vol 373 (9673) ◽  
pp. 1447-1454 ◽  
Author(s):  
Gary King ◽  
Emmanuela Gakidou ◽  
Kosuke Imai ◽  
Jason Lakin ◽  
Ryan T Moore ◽  
...  
Keyword(s):  
Public Policy ◽  
Health Insurance ◽  
Universal Health Insurance ◽  
The Poor ◽  
Insurance Programme ◽  
Universal Health ◽  
Health Insurance Programme

The Case for Universal Health Insurance

2019 ◽  
pp. 233-247
Author(s):  
Alex Rajczi
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Affordable Care Act ◽  
Universal Health Insurance ◽  
Complete Case ◽  
Personal Cost ◽  
Single Payer ◽  
Fiscal Risk ◽  
The Face ◽  
Universal Health

The previous chapters have examined three significant objections to universal health insurance—objections focused on fiscal risk, efficacy, and personal cost. This chapter synthesizes the responses to those concerns, revealing that they fit together into a single, coherent outlook on the ethics of health care. It is argued that in light of the considerations offered in previous chapters, the Affordable Care Act is problematic—deserving of support only in the face of inferior alternatives. In contrast, there are no similar problems with well-designed single-payer or regulated-market systems. The chapter concludes with some reflections on the next steps in a complete case for universal health insurance.

scholarly journals Prevalence of Frailty Indicators and Association with Socioeconomic Status in Middle-Aged and Older Adults in a Swiss Region with Universal Health Insurance Coverage: A Population-Based Cross-Sectional Study

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Idris Guessous ◽  
Jean-Christophe Luthi ◽  
Christopher Barrett Bowling ◽  
Jean-Marc Theler ◽  
Fred Paccaud ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Population Based ◽  
Universal Health Insurance ◽  
Middle Aged ◽  
Universal Health Insurance Coverage ◽  
Middle Aged Adults ◽  
Universal Health

Frailty prevalence in older adults has been reported but is largely unknown in middle-aged adults. We determined the prevalence of frailty indicators among middle-aged and older adults from a general Swiss population characterized by universal health insurance coverage and assessed the determinants of frailty with a special focus on socioeconomic status. Participants aged 50 and more from the population-based 2006–2010 Bus Santé study were included (N= 2,930). Four frailty indicators (weakness, shrinking, exhaustion, and low activity) were measured according to standard definitions. Multivariate logistic regressions were used to determine associations. Overall, 63.5%, 28.7%, and 7.8% participants presented no frailty indicators, one frailty indicator, and two or more frailty indicators, respectively. Among middle-aged participants (50–65 years), 75.1%, 22.2%, and 2.7% presented 0, 1, and 2 or more frailty indicators. The number of frailty indicators was positively associated with age, hypertension, and current smoking and negatively associated with male gender, body mass index, waist-to-hip ratio, and serum total cholesterol level. Lower income level but not education was associated with higher number of frailty indicators. Frailty indicators are frequently encountered in both older and middle-aged adults from the Swiss general population. Despite universal health insurance coverage, household income is independently associated with frailty.

scholarly journals House Officers’ Choice of Family Medicine Specialty amid the Implementation of the New Universal Health Insurance Law

2021 ◽  
Vol 12 ◽  
pp. 215013272110189
Author(s):  
Marwa Mostafa Ahmed ◽  
Samar Fares ◽  
Asmaa Ahmed Sayed ◽  
Inas Talat ElSayed ◽  
Saeed S. A. Soliman
Keyword(s):  
Health Insurance ◽  
Family Medicine ◽  
Cross Sectional Study ◽  
Universal Health Insurance ◽  
University Hospitals ◽  
Questionnaire Response ◽  
Cross Sectional ◽  
Insurance Law ◽  
Recent Graduates ◽  
Universal Health

Background The new Egyptian Universal Health Insurance Law is introduced through family-oriented primary health care. Increasing the number of recent graduates who specialized in family medicine is considered a national need to overcome family physicians’ shortage. Aim To explore the factors affecting the house officers’ choice of Family Medicine as a future career amid the implementation of the new Universal Health Insurance Law in Egypt. Methods This is a cross-sectional study conducted on house officers during their training in Cairo university hospitals from the first of March 2020 to February 2021. The researchers offered an anonymous self-administered questionnaire to all house officers at the beginning of their 2-week family medicine training (1170 house officers). Results A total of 1052 completed the questionnaire (response rate 90%). Family medicine as a specialty was considered by 53.6% (n = 564) of participants, while only 23.4% (n = 246) of participants had an obvious intention to choose family medicine. Multivariate (adjusted) logistic regression model revealed that factors significantly associated with intention to choose family medicine were marital status, knowledge about governmental advantages for family medicine offered to the specialized recent graduates, and previously encountered with family practice as customers. Conclusions The choice of family medicine specialty is increasing among house officers. This could be attributed to the growing interest in family medicine in Egypt, especially after implementing the new insurance law’s first phase in several Egyptian governorates.

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