Tsai Ching Liu

Urbanization and stroke prevalence in Taiwan: analysis of a nationwide survey.

This study aims to explore the prevalence of strokes among individuals and the association with urbanization levels. A total sample of 9,794 individuals was obtained from a nationwide survey on Taiwan for subsequent analysis in this study. After adjusting for gender, age, other risk factors for stroke and individual socioeconomic status, a multivariate logistic regression model was employed to investigate the relationships existing between the prevalence of strokes and the level of urbanization. This study finds that those living in areas at the highest level of urbanization (level 1) had the highest prevalence of strokes (2.49%). With decreasing urbanization level, there was a general decline in stroke prevalence. After adjusting for other factors, the multivariate logistic regression analyses showed that compared to participants living in the highest urbanization level, the respective odds ratios of suffering a stroke for those living in areas at the lowest levels of urbanization (levels 7 and 8), were 0.43 and 0.30. We conclude that after adjusting for other stroke risk factors, the level of urbanization is an important contributory factor to the overall prevalence of strokes in Taiwan.

Does high surgeon and hospital surgical volume raise the five-year survival rate for breast cancer? A population-based study

This study sets out to examine the relationship between both surgeon and hospital volume and five-year survival rates for breast cancer patients. We performed Cox proportional hazard regressions on a pooled population-based database linking the Taiwan National Health Insurance Research Database with the ‘cause of death’ data file, covering the three-year period from January 1997 to December 1999. Of the 13,360 breast cancer resection patients in our study sample, the five-year survival rates, by surgeon volume, were 77.3% in the high-volume group (>201 cases), 76.9% in the medium-volume group (45–200), and 69.5% in the low-volume group (≤44). The five-year survival rates, by hospital volume, were 77.3% for high-volume hospitals (>585 cases), 74.5% for medium-volume hospitals (259–585) and 72.1% for low-volume hospitals (≤258). Cox regression analyses show that the risk of death for patients treated by low-volume surgeons was up to 1.305 times (Pxa0<xa00.001) as high as the risk for those treated by high-volume surgeons. Similarly, the risk of death for patients whose resections had been performed in low-volume hospitals was 1.484 times (Pxa0<xa00.001) as high as the risk for those whose resections had been performed in high-volume hospitals. High surgeon or hospital volume contributes significantly to patient outcomes and may be regarded as an overall indicator of high treatment quality; we therefore strongly recommend that the healthcare authorities reveal to the public all of the relevant information on provider performance and caseloads in order to assist them to make the optimum choice when surgery becomes necessary.

The association between readmission rates and length of stay for schizophrenia: A 3-year population-based study

OBJECTIVEnA nationwide population-based dataset was used to explore the association between length of stay (LOS) and 30-day readmission rates for hospitalized patients with schizophrenia in Taiwan.nnnMETHODSnThe National Health Insurance Research Database was used for the years 2001-2003 and included a total of 29,373 patients with schizophrenia divided equally into four groups according to LOS of index hospitalization. After adjusting for hospital, physician and patient characteristics, a multivariate regression analysis was used to determine the relationship between LOS and 30-day readmission rates.nnnRESULTSnAfter discharge from their index hospitalization, 12,468 (42.5%) patients with schizophrenia were readmitted within 30 days. The adjusted odds ratio for 30-day readmission rates was increased for shorter LOS.nnnCONCLUSIONSnHealthcare providers should exert caution while trying to reduce LOS within the current cost-conscious environment and balance it with creating a minimal status necessary for discharge.

Household out-of-pocket medical expenditures and national health insurance in Taiwan: income and regional inequality

BackgroundUnequal geographical distribution of medical care resources and insufficient healthcare coverage have been two long-standing problems with Taiwans public health system. The implementation of National Health Insurance (NHI) attempted to mitigate the inequality in health care use. This study examines the degree to which Taiwans National Health Insurance (NHI) has reduced out-of-pocket medical expenditures in households in different regions and varying levels of income.MethodsData used in this study were drawn from the 1994 and 1996 Surveys of Family Income and Expenditure. We pooled the data from 1994 and 1996 and included a year dummy variable (NHI), equal to 1 if the household data came from 1996 in order to assess the impact of NHI on household out-of-pocket medical care expenditures shortly after its implementation in 1995.ResultsAn individual who was older, female, married, unemployed, better educated, richer, head of a larger family household, or living in the central and eastern areas was more likely to have greater household out-of-pocket medical expenditures. NHI was found to have effectively reduced household out-of-pocket medical expenditures by 23.08%, particularly for more affluent households. With the implementation of NHI, lower and middle income quintiles had smaller decreases in out-of-pocket medical expenditure. NHI was also found to have reduced household out-of-pocket medical expenditures more for households in eastern Taiwan.ConclusionAlthough NHI was established to create free medical care for all, further effort is needed to reduce the medical costs for certain disadvantaged groups, particularly the poor and aborigines, if equality is to be achieved.

Contact of Mental and Nonmental Health Care Providers Prior to Suicide in Taiwan : A Population-Based Study

Objective: Higher rates of health care service use prior to suicide were previously reported in Western countries; however, these studies have tended to suffer from small sample sizes. This nationwide, population-based study examines the distribution and patterns of health care service use among suicide victims in Taiwan. Method: A retrospective cohort study was conducted using linked population-based data to determine the proportion of health care service use among suicide victims aged 15 years and older within the 1-year and 1-month period prior to their deaths. After adjusting for demographic, socioeconomic and health care indices, the differences in health care service use patterns were assessed for age and sex. Results: Among the 19 426 suicide victims in the sample, 83.1% had used nonmental health care services within the 1-year period prior to their death, while only 22.2% had used mental health care services. Men, and suicide victims aged 55 years and older, were less likely to have had any contact with mental health care professionals prior to their deaths (P < 0.001). Conclusions: In line with prior studies, similarly high rates and distinct patterns of health care service use were found in Taiwan prior to suicide. These findings will be of practical interest and should support designing appropriate methods of suicide intervention and effective preventive strategies.

The demand for preventive care services and its relationship with inpatient services.

OBJECTIVEnTo examine not only the relationship between the utilization of preventive health care services and inpatient services, but to also investigate the factors affecting the utilization of such services by the middle-aged and elderly.nnnMETHODnWe use data obtained from the 2003 Survey of Health and Living Status of the Elderly in Taiwan (SHLSE), hypothesizing that preventive health care services can be regarded as an appropriate substitute for subsequent medical services such as inpatient services; a recursive simultaneous model is used to avoid the problems of endogeneity.nnnRESULTSnThe main results of this study indicate that the utilization of preventive health care services has the effect of reducing the probability of the utilization of inpatient services.nnnCONCLUSIONnThe utilization of preventive care services can help to promote healthier lifestyles, provide early detection of illnesses, and reduce the need for subsequent inpatient care services amongst individuals. We suggest that effective outreach strategies to promote the utilization of preventive care services are essential.

Does elective caesarean section increase utilization of postpartum maternal medical care

Background:There have been no studies that quantitatively assess postpartum maternal medical care utilization for elective caesarean section (CS) versus vaginal delivery procedures. Methods:This study used population-based data linked with birth file data to explore the association between delivery modes (elective CS vs. vaginal delivery) and the utilization of postpartum maternal medical care (outpatient visits and inpatient care) during the 6-month postdelivery period. The analysis was restricted to term deliveries to avoid biased estimation. Results:The average number of postpartum outpatient visits for elective CS (3.14) was slightly higher than the average number of visits for vaginal deliveries (2.87). Similarly, the total amount of postpartum maternal medical expenditures involved was slightly higher for elective CS than for vaginal deliveries [NT

Urbanization and place of death for the elderly: a 10-year population-based study

2811 (US

Urbanization and the likelihood of a cesarean section.

73.6) vs. NT

The relationship between depressive symptoms and health service utilization for elderly people in Taiwan

2570 (US