Wei Hua Tian

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

OBJECTIVE A 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. METHODS The 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. RESULTS After 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. CONCLUSIONS Healthcare 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.

Utilization of health care services by elderly people with National Health Insurance in Taiwan: The heterogeneous health profile approach

OBJECTIVES Taiwan is now facing an increased prevalence of aging related diseases and escalating healthcare costs. Within the context of the health care system and NHI in Taiwan, the aim of this study was to examine the health profiles of elderly people by using Latent Class Analysis to determine the effects of different health profiles on the health care services utilization and expenditures, and to examine the factors associated with by controlling for the health profiles of elderly people. METHODS Data came from the 2005 National Health Interview Survey in Taiwan. Among those who were interviewed, 2449 elderly individuals with available health indicators were identified, and 1491 of these had complete socio-economic data and linkage to their utilization of health care services from 2004 to 2007 were analyzed. RESULTS Four health profiles were identified. The effect of the different health profiles of elderly people on the likelihood of utilization and expenditure on health care services was significant. While comparing with Relative Healthy group, the High Comorbidity group tended to utilize more services in the ambulatory care. The functional impairment group had relatively high probabilities of needing care assistance and the Frail group had higher health care expenditures. Age and gender did not have a significant effect and other associated socio-economic factors were also discussed. CONCLUSIONS The health status of elderly people includes a variety of health indicators. We suggest that a person-centered approach is needed in order to satisfy needs and forecast expenditures in the future.

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

OBJECTIVE To 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. METHOD We 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. RESULTS The 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. CONCLUSION The 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.

Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan

OBJECTIVES This study aims to investigate the relationship between the level of urbanization and the utilization of outpatient services under the National Health Insurance (NHI) program in Taiwan. METHODS We adopted a two-part model using data from the 2001 National Health Interview Survey (NHIS) and the 2001 National Health Insurance Research Database (NHIRD) in Taiwan. Data for a total of 20,640 individuals were obtained for subsequent analysis in this study. RESULTS The results of the first part, the contact analysis, indicate that individuals residing in areas with lower urbanization levels are less likely to use outpatient services compared to those residing in areas with the highest urbanization levels. The second part of the frequency analysis revealed that, for those individuals that had previously utilized outpatient services, those residing in areas with lower urbanization levels tended to utilize outpatient services less than individuals residing in areas with higher levels of urbanization. CONCLUSIONS Our empirical results show that differences between urbanization levels are a major contributory factor associated with the probability and frequency of outpatient utilization in Taiwan.

The State Children's Health Insurance Program: Participation and Substitution

Abstract We examine the effects of SCHIP enactment by focusing on two policy concerns: take-up and crowd-out. The literature has examined how income eligibility expansions affect the type of childrens insurance coverage. However, states jointly implemented various policy instruments. The results in previous works do not control for this variety. We analyze how changes in several SCHIP factors affected decisions regarding health insurance coverage. Our analysis indicates that the estimates in the literature may have combined the effects of various policy factors. In distinguishing individual policy factors, our results provide useful information for designing effective public health insurance programs.

The heterogeneous health latent classes of elderly people and their socio-demographic characteristics in Taiwan

The health care needs of elderly people were influenced by their heterogeneity. This study aimed to identify the health latent classes of elderly people by using latent class analysis to deal with heterogeneity and examine their socio-demographic characteristics. Data came from the 2005 National Health Interview Survey (NHIS) in Taiwan. In total, 2449 elderly individuals with available health indicators were examined in latent class analysis (LCA), and 2217 elderly community-dwellings with complete socio-demographic data were analyzed by multinomial logistic regression. Four health latent classes were identified which included 1066 (43.5%) people in the High Comorbidity (HC), 152 (6.2%) in the Functional Impairment (FI), 252 (10.3%) in the Frail (FR), and 979 (40.0%) in the Relatively Healthy (RH) group. Multinomial logistic regressions revealed socio-demographic characteristics among health classes. The variables associated with an increased likelihood of being in the FR group were age, female, and living with families. They were also correlated to ethnicity and educations. Apart from age and gender, the Functional Impairment group was less likely to be ethnicity of Hakka, more likely to live with others than were the RH group. The HC group tended to be younger, with higher educations, and more likely to live in urban area than the Functional Impairment group. The correlations between health classes and socio-demographic factors were discussed. The health status of elderly people includes a variety of health indicators. A person-centered approach is critical to identify the health heterogeneity of elderly people and manage their care needs by targeting differential aging.

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

OBJECTIVE This study analyzes the relationship between depressive symptoms and the utilization of medical services for elderly people in Taiwan. METHODS Because depressive symptoms and physical health may have a reciprocal relationship, a simultaneous equations model was used by performing a 3-stage least squares (3SLS) regression. The data in this study were obtained from the 2003 Survey of Health and Living Status of the Elderly in Taiwan (SHLSE). RESULTS The findings show that depressive symptoms have a significantly negative effect on the utilization of outpatient, inpatient, and emergency services. Furthermore, the magnitude of the 3SLS estimates of physical health status in relation to health service utilization is substantially greater than that in the OLS estimates. The results may reveal that people with depressive symptoms may seek healthcare services because of physical discomfort. CONCLUSIONS Those with depressive symptoms may not seek specialty mental treatments, suggesting that policy interventions to monitor the need to care for elderly people with depressive symptoms through primary care services are important in screening and maintaining the mental health of elderly people.

The Effect of Free Adult Preventive Care Services on Subsequent Utilization of Inpatient Services in Taiwan.

The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals’ utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program.