Tung-Liang Chiang

Taiwan's 1995 health care reform.

Under considerable domestic political pressure, the Taiwan government inaugurated a compulsory universal health insurance scheme on 1 March 1995. This new scheme is financed mainly by payroll tax and provides comprehensive health care benefits with a moderate cost sharing. In order to gain efficiency in delivering health services, the scheme enters contracts with health care providers and has been developing a prospective payment system. Meanwhile, the scheme uses a uniform fee schedule and makes all payments through a public single-payer system to control health care costs. By the end of the inaugural year, the scheme covered 92% of the population and the utilization pattern of the newly insured became close to that of the previously insured. However, there is the beginning of a financial crisis because the payments of the scheme are rapidly increasing and expect to exceed the premiums in the coming year. Besides, the scheme did not bring in the efficient use of health care resources and probably caused it to worsen. Taiwans health care reform has an unfinished agenda.

Economic transition and changing relation between income inequality and mortality in Taiwan: regression analysis

Abstract Objective: To examine the changing relation between income inequality and mortality through different stages of economic development in Taiwan. Design: Regression analysis of mortality on income inequality for three index years: 1976, 1985 and 1995. Setting: 21 counties and cities in Taiwan. Main outcome measures: All age mortality and age specific mortality in children under age 5. Results: When median household disposable income was controlled for, the association between income inequality and mortality became stronger in 1995 than in 1976. Especially, the association between income inequality and mortality in children aged under 5, with adjustment for differences in median household disposable income, changed from non-significant in 1976 to highly significant in 1995. In 1995, the level of household income after adjustment for income distribution no longer had a bearing on mortality in children under 5. Conclusion: The health of the population is affected more by relative income than by absolute income after a country has changed from a developing to a developed economy. Key messages Income distribution may be more important than the level of income in determining population health in developed countries but has not been examined in a country through different stages of economic development Along with economic development, gross national product per capita in Taiwan has increased rapidly from less than US

Stroke prevalence in Taiwan: Findings from the 1994 National Health Interview survey

200 (£72) in 1953 to US

Predicting risk for early infantile atopic dermatitis by hereditary and environmental factors.

1132 (£627) in 1976 and to US

Evolution of Taiwan’s health care system

12 396 (£7853) in 1995 In Taiwan the association between income distribution and mortality was stronger in 1995 than in 1976, contrary to the association between absolute income and mortality, which was stronger in 1976 than in 1995 The effect of income distribution on age specific mortality rate in children under 5 became highly significant whereas the effect of absolute income became non-significant in 1995

Predictive validity of Bayley scale in language development of children at 6-36 months.

BACKGROUND AND PURPOSE Stroke has been the second leading cause of death for all ages in Taiwan since 1983. However, despite the severity of the threat, stroke prevalence in Taiwan has not yet been addressed in a nationwide survey. In this study, the stroke prevalence in Taiwan was investigated using data from the 1994 National Health Interview Survey. METHODS This nationwide survey sought to obtain a nationally representative sample of households in Taiwan by using three-stage stratified random sampling with a probability proportional to size. In the first stage, 58 townships were selected, from the 359 townships in Taiwan, according to their administrative structure and level of socioeconomic development. In the second stage, 149 basic administrative regions (tsun or li) were selected from the selected 58 townships. Finally, 3814 households were selected from the 149 selected tsuns or lis. Field interviews were carried out between October 1994 and December 1994. Follow-up interviews with families of stroke patients were made 2 years later. RESULTS Of the selected households 3119, or 81.8%, responded. A total of 11925 persons were interviewed, and 71 of them were stroke patients, with a crude point prevalence rate of 5.95 per 1000. The stroke prevalence increased steadily with age, from 0.51 per 1000 in persons aged 35 to 44 years to 113.6 per 1000 in persons aged 85 years or over. There was a weak association with higher stroke prevalence for persons living in eastern Taiwan or those of lower educational level. The overall male/female prevalence ratio was 1.17. The results of follow-up interviews showed a cumulative mortality rate of 25.4% within the 2-year period and an ischemic/hemorrhagic stroke ratio of 1.33 in 35 patients whose stroke type could be validated. CONCLUSIONS Age was the most important factor correlating to stroke prevalence. On the basis of this result, planning policies and programs for stroke prevention in Taiwan should give a higher priority to (1) aggressive primary prevention for aged people who are apparently at higher risk of stroke and (2) early reduction of stroke risk factors in younger aged people whose immediate risk of stroke is lower but would increase significantly with age.

Gender differences of children's developmental trajectory from 6 to 60 months in the Taiwan Birth Cohort Pilot Study

Background  Hereditary and environmental factors contribute to the occurrence of atopic dermatitis (AD). However, the interaction of these two factors is not totally understood.

The structure of the mental health inventory among Chinese in Taiwan

This study aims to present an overview of the evolutionary policy process in reforming the health care system in Taiwan, through dissecting the forces of knowledge, social-cultural context, economic resources and political system. We further identify factors, which had a significant impact on health care reform policies in Taiwan through illustrative policy examples. One of the most illuminating examples highlighted is the design and implementation of a single-payer National Health Insurance (NHI) program in 1995, after nearly five years of planning efforts (1988-1993) and a two-year legislative marathon. The NHI is one of the most popular social programs ever undertaken in the history of Taiwan, which greatly enhances financial protection against unexpected medical expenses and assures access to health services. Nonetheless, health care reform still has an unfinished agenda. Despite high satisfaction ratings, Taiwans health care system today is encountering mounting pressure for new reforms as a result of its rapidly aging population, economic stagnation, and imbalanced NHI checkbook. Although there may exist some heterogeneous system characteristics and challenges among different health care systems around the world, Taiwans experiences in reforming its health care system for the past few decades may provide valuable lessons for countries going through rapid economic and political transition.

Efficient developmental screening instrument for 6-and 18-month-old children in the Taiwan Birth Cohort Pilot Study

Background:  The aim of the present study was to investigate the prediction of development among 6‐, 18‐, and 36‐month‐old infants on the Bayley Scale of Infant Development (BSID).

Parental mental health, education, age at childbirth and child development from six to 18 months.

The parental report instrument is the most efficient developmental detection method and has shown high validity with professional assessment instruments. The reliability and validity of the Taiwan Birth Cohort Study (TBCS) 6-, 18- and 36-month scales have already been established. In this study, the reliability and validity of the 60-month scale was tested. The gender differences in childrens longitudinal gross motor, fine motor, language and social development were also investigated. Using the dataset from the Taiwan Birth Cohort Pilot Study (TBCS-p), 2048 infants were followed up when they were 6-, 18-, 36- and 60-month-old. At the final stage, 1620 children were followed up. Development of the children was measured using the TBCS 6-, 18-, 36-, and 60-month developmental scales. The reconstructed TBCS 60-month scale yielded 16 items measuring childrens development in the four dimensions of gross motor, fine motor, language and social. The scale yielded an internal consistency of 0.39-0.71. Structural equation modeling also showed good construct and predictive validity, in that the 6-, 18-, and 36-month scales were predictive of the 60-month scale. No gender differences between the gross motor dimension was found. Gender had an effect on the fine motor dimension at 36 and 60 months, language dimension at 36 months, and social dimension at 18, 36 and 60 months. Gender had a transient effect in language development and social development a continuous effect from 18 to 60 months. Thus different gender norms may need to be established to prevent misdiagnosis. The TBCS scale is a valid and reliable developmental screening instrument that can be used in continuous surveillance of childrens development in community and clinical settings from 6 months to 5 years of age.