scholarly journals The Impacts of the Hierarchical Medical System on National Health Insurance on the Resident’s Health Seeking Behavior in Taiwan: A Case Study on the Policy to Reduce Hospital Visits

2019 ◽  
Vol 16 (17) ◽  
pp. 3167 ◽  
Author(s):  
Yu-Hua Yan ◽  
Chih-Ming Kung ◽  
Horng-Ming Yeh
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Medical System ◽  
Medical Attention ◽  
Healthcare Seeking ◽  
Outpatient Visits ◽  
Seeking Behavior ◽  
Healthcare Seeking Behavior ◽  
Hierarchical Medical System

Objective: This study investigated the impacts of the hierarchical medical system under the national health insurance program on residents’ healthcare-seeking behavior in Taiwan. Background: Healthcare authorities in Taiwan initiated an allowance reduction for outpatient visits at regional hospitals and higher hierarchical hospitals in 2018. The ultimate goal is to implement a hierarchical medical system to provide residents accessible as well as consistent medical services. Methods: This research was conducted through a questionnaire survey, and data were collected between August and December 2018 from the records of subjects who had recently sought medical attention. A total of 1340 valid questionnaires were returned. Results: A principal finding was that there were significant differences in the knowledge of new policies by age, marital status, annual income, education level, and occupation (p < 0.001). Regarding the effects on healthcare-seeking behavior, there were significant differences from persons aged 40–49 years (p < 0.1), in junior high school (p < 0.05), not aware of the policy (p < 0.001), and awareness of both the hierarchical medical system and the policy to reduce outpatient visits to large hospitals (p < 0.001). Conclusion: The health administration authorities should devote more effort into promoting knowledge of the policy in order to better inform the public about the hierarchical medical system.

scholarly journals Health care seeking behavior for common childhood morbidities in Ethiopia: The effects of maternal behavior and access to key health services

2020 ◽  
Author(s):  
Cindy Xin Feng ◽  
Nigatu R Geda ◽  
Susan J Whiting ◽  
Rein Lepnurm ◽  
Carol J Henry ◽  
...  
Keyword(s):  
Working Mothers ◽  
Survey Design ◽  
Medical Attention ◽  
Demographic And Health Surveys ◽  
High Morbidity ◽  
Care Seeking ◽  
Health Seeking ◽  
Healthcare Seeking ◽  
Seeking Behavior ◽  
Healthcare Seeking Behavior

Abstract Background: Childhood morbidities such as diarrhea and pneumonia are the leading causes of death in Ethiopia. Appropriate healthcare-seeking behavior of mothers for common childhood illnesses could prevent a significant number of these early deaths; however, little nation-wide research has been conducted in Ethiopia to assess mothers’ healthcare-seeking behavior for their children.Method: The study used the Ethiopian Demographic and Health Surveys (EDHS) conducted in 2016 on a nationally representative sample of 10641 children under the age of five. The main determinants of care-seeking during diarrhea and Acute Respiratory Infection (ARI) episodes were assessed using multiple logistic regression analyses while adjusting for complex survey design.Results: Only 43% and 35% of households sought medical attention for their children in episodes of diarrhea and ARI, respectively, during a reference period of two weeks before the survey. The odds of seeking care for diarrhea are lower for non-working mothers versus working mothers. The likelihood of seeking care for diarrhea or ARI is higher for fathers who had education versus no education. The place of delivery for the child, receiving postnatal checkup and getting at least one immunization in the past determined the likelihood of seeking care for ARI, but not for diarrhea. The odds of seeking care are higher for both diarrhea and ARI among households that are headed by females and where mothers experienced domestic violence. Religion and types of family structure are also significant factors of seeking care for diarrhea episodes, but not for ARI.Conclusion: Given the high morbidity and mortality rates for children in Ethiopia, a deeper understanding of the health-seeking behaviour of mothers may provide insights for identifying the potential gaps and developing improvement of mothers’ awareness and perception towards childhood problems

scholarly journals Age Structural Transitions and Copayment Policy Effectiveness: Evidence from Taiwan’s National Health Insurance System

2020 ◽  
Vol 17 (12) ◽  
pp. 4183
Author(s):  
Ya-Ling Lin ◽  
Wen-Yi Chen ◽  
Shwn-Huey Shieh
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Medical Center ◽  
Structural Transitions ◽  
Policy Effectiveness ◽  
Ageing Society ◽  
Policy Responses ◽  
Outpatient Visits ◽  
The Impact

Background: Population ageing is a worldwide phenomenon that could influence health policy effectiveness. This research explores the impact of age structural transitions on copayment policy responses under Taiwan’s National Health Insurance (NHI) system. Methods: The time-varying parameter vector autoregressive model was applied to create two measures of the copayment policy effectiveness, and multiple linear regression models were used to verify the nonlinear effect of age structural transitions on copayment policy responses. Results: Our results show that copayment policy effectiveness (in terms of the negative response of medical center outpatient visits to upward adjustments in copayment) is positively correlated with the proportions of the population in two older age groups (aged 55–64 and ≥ 65) and children (age < 15), but negatively correlated with the proportion of the population that makes up most of the workforce (aged 15‒54). These tendencies of age distribution, which influence the responses of medical center outpatient visits to copayment policy changes, predict that copayment policy may have a greater influence on medical center outpatient utilization in an ageing society. Conclusions: Policymakers should be concerned about the adverse effects of copayment adjustments on the elderly, such as an increasing financial burden and the effect of pricing some elderly patients out of Taiwan’s NHI system.

scholarly journals The effect of shifting medical coverage from National Health Insurance to Medical Aid type I and type II on health care utilization and out-of-pocket spending in South Korea

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Doo Woong Lee ◽  
Jieun Jang ◽  
Dong-Woo Choi ◽  
Sung-In Jang ◽  
Eun-Cheol Park
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Utilization ◽  
National Health Insurance ◽  
National Health ◽  
Care Utilization ◽  
Type I ◽  
Type Ii ◽  
Medical Aid ◽  
Outpatient Visits

Abstract Background This study examines the effects of a shift in medical coverage, from National Health Insurance (NHI) to Medical Aid (MA), on health care utilization (measured by the number of outpatient visits and length of stay; LOS) and out-of-pocket medical expenses. Methods Data were collected from the Korean Welfare Panel Study (2010–2016). A total of 888 MA Type I beneficiaries and 221 MA Type II beneficiaries who shifted from the NHI were included as the case group and 2664 and 663 consecutive NHI holders (1:3 propensity score-matched) were included as the control group, respectively. We used the ‘difference-in-differences’ (DiD) analysis approach to assess changes in health care utilization and medical spending by the group members. Results Differential average changes in outpatient visits in the MA Type I panel between the pre- and post-shift periods were significant, but differential changes in LOS were not found. Those who shifted from NHI to MA Type I had increased number of outpatient visits without changes in out-of-pocket spending, compared to consecutive NHI holder who had similar characteristics. However, this was not found for MA Type II beneficiaries. Conclusion Our research provides evidence that the shift in medical coverage from NHI to MA Type I increased the number of outpatient visits without increasing the out-of-pocket spending. Considering the problem of excess medical utilization by Korean MA Type I beneficiaries, further researches are required to have in-depth discussions on the appropriateness of the current cost-sharing level on MA beneficiaries.

scholarly journals THE IMPACT OF NATIONAL HEALTH INSURANCE POLICY ON OUTPATIENT VISIT IN MALUKU AND PAPUA: LOGIT MODEL

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Rira Wahdani Martaliza ◽  
Pujiyanto Pujiyanto
Keyword(s):  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Secondary Data ◽  
Outpatient Visits ◽  
Econometric Approach ◽  
Logit Regression Model ◽  
The Impact ◽  
Positive Effect ◽  
System Program

AbstractThe National Health Insurance (JKN) is one manifestation of the National Social Security System program which aims to provide benefits for health care and protection. This study uses secondary data from the 2017 National Socio-Economic Survey (Susenas) which aims to prove that JKN ownership has an influence on outpatient visits. The research respondents were all people who were registered as JKN participants in the Maluku and Papua Islands regions as many as 77.307 people. This study uses the econometric approach with the Logit regression model. The results showed that JKN was positively associated with outpatient visits, with coefficients of PBI (0,713) and Non PBI (0,807). The results also showed that age had a positive effect on outpatient visits with a coeficent value (0,406), gender had a positive effect on outpatient visits with a coefficient (0,146), employment status negatively affected outpatient visits with a coefficient value (-0,198) likewise the health status has a positive effect on outpatient visits with a coefficient (3,914). JKN ownership has an important role for the community in fulfilling the utilization of health facilities when suffering from health complaints, one of which is the use of outpatient visits.AbstrakJaminan Kesehatan Nasional (JKN) merupakan salah satu wujud dari program Sistem Jaminan Sosial Nasional yang bertujuan untuk memberikan manfaat pemeliharaan dan perlindungan kesehatan. Penelitian ini menggunakan data sekunder Survei Sosial Ekonomi Nasional (Susenas) tahun 2017 yang bertujuan untuk membuktikan bahwa kepemilikan JKN memberikan pengaruh terhadap kunjungan rawat jalan. Responden penelitian adalah seluruh masyarakat yang berada di wilayah Kepulauan Maluku dan Papua yang memenuhi kriteria inklusi sebanyak 77.307 orang. Penelitian ini menggunakan pendekatan ekonometrika dengan model regresi Logit. Hasil penelitian menunjukkan bahwa JKN berhubungan positif dengan kunjungan rawat jalan, dengan nilai koefisien PBI (0,713) dan Non PBI (0,807). Hasil penelitian juga menunjukkan bahwa umur berpengaruh positif terhadap kunjungan rawat jalan dengan nilai koefisin (0,406), jenis kelamin berpengaruh positif terhadap kunjungan rawat jalan dengan nilai koefisien (0,146), status pekerjaan berpengaruh negatif terhadap kunjungan rawat jalan dengan nilai koefisien (-0,198), begitu juga dengan status kesehatan berpengaruh positif terhadap kunjungan rawat jalan dengan koefisien (3,914). Kepemilikan JKN memiliki peranan penting bagi masyarakat dalam memenuhi pemanfaatan fasilitas kesehatan ketika menderita keluhan kesehatan, salah satunya dengan pemanfaatan kunjungan rawat jalan.

scholarly journals Synergy of policies to strengthen primary care: evidence from a national repeated cross-sectional study

2020 ◽  
Author(s):  
Yinzi Jin ◽  
Jin Xu ◽  
Weiming Zhu ◽  
Yaoguang Zhang ◽  
Ling Xu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health Workforce ◽  
Healthcare Seeking ◽  
Percentage Points ◽  
Level Data ◽  
Seeking Behavior ◽  
Healthcare Seeking Behavior ◽  
Negative Impacts ◽  
The Impact

Abstract Background: People bypass primary healthcare (PHC) institutions to seek expensive healthcare at high-level hospitals, leading to escalating medical costs and inefficient use of resources. In 2009, China launched nationwide synergic policies on primary care strengthening, to tackle access to healthcare and financial protection. This study aimed to assess the impact of the two policy areas, health insurance and health workforce, on healthcare seeking behavior. Methods: Drawing on national survey data before (2008) and after (2013) the policies, we linked individual-level data on healthcare-seeking behavior with county-level data on health workforce and health insurance. We constructed a multilevel zero-inflated negative binomial regression to examine the impacts of average reimbursement rate (ARR) of health insurance and the density of registered physicians on outpatient/inpatient visits, and multilevel multinomial logistic regression for the impacts on choice of outpatient/inpatient care providers. Results : Although the increase in health insurance ARR and physician density have positive impacts on individuals’ healthcare use, their impacts might be weakened during 2008 and 2013, and the negative impacts of investment of those in PHC institutions on likelihood of visiting hospitals was larger. The negative impacts of ARR at PHC institutions on likelihood of visiting county-, municipal- and higher-level hospitals in 2013 was 28 percentage points, 66 percentage points and 33 percentage points larger than these in 2008. Conclusions: Primary care strengthening requires synergic policies. Effective mechanisms for coordination across multisectoral actions are necessities for deepening those policies to ensure efficient delivery of healthcare without experiencing financial risks.

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