Drunk driving policies and breath test refusal in Taiwan.

OBJECTIVE: Driving under the influence (DUI) is one of the major causes of traffic crashes in Taiwan, leading to huge medical expenditures and human capital loss. Although the authorities have enacted several policies to reduce drunk driving, most penalties are based on drunk drivers' alcohol levels. According to Taiwan regulations, drivers could pay a fine to refuse the breath test if they are not involved in a traffic collision, and there is no clear evidence showing that they are DUI. Therefore, increased sanctions for DUI may lead to increased breath test refusals. If breath tests for drunk driving could be refused with little or no punishments for drivers, then the detection of behavioral impairment would weaken, and the deterrent effect of DUI punishment would be limited. METHOD: This research uses interrupted time-series analysis (ITSA) to examine how policy reforms from 2007 to 2020 affected driver's breath refusal rate in Taiwan. RESULTS: We find that said reforms that exclusively increase the punishment of DUI offenders did raise the refusal rate immediately and persistently, suggesting that more drunk drivers would refuse a breath test to avoid more severe DUI punishment. Policy reforms that increase penalties for drivers refusing to take breath tests may instantly lower the refusal rate, but the long-term effects are contingent upon the DUI punishment. CONCLUSIONS: It appears that drunk drivers could still decide on breath test refusal to avoid a DUI conviction if the punishment for refusing the test is less severe than that for DUI. Aggravating penalties for refusing breath tests would decrease the refusal rate and help reinforce DUI's deterrent effect.

The effects of road safety education on the occurrence of motorcycle violations and accidents for novice riders: An analysis of population-based data.

The prevalence of motorcycle riding among novice riders in most Southeast Asia countries presents an alarming rate of traffic violations and fatal accidents. Since 2013, Taiwan's government has gradually required a road safety class (RSC) for the rider's licensing process. The RSC consisted of watching videotapes of motorcycle-involved crashes followed by lectures on safety measures. Our study tried to see whether a compulsory RSC could lower the likelihood and frequency of road accidents and traffic violations among novice riders. To avoid self-selection bias, we selected 480,114 novice riders aged 18-20 years, licensed one year before starting the trial period and one year after full implementation of RSC. Using the 2012-2018 data from the Taiwan Ministry of Transportation and Communication (MOTC), we applied the logistic model to evaluate RSC effects on the risk of violations and accidents. Then, we used the negative binomial regression to model their frequency in response to RSC exposure. Following the novice drivers 1-3 years after licensing, our results showed that the RSC has a short-term effect in lowering their traffic violations' likelihood by 12%∼17% and their frequency by 11%; however, the RSC effects only last two years in reducing the counts of motorcycle-involved offenses and accidents. The RSC reduction effect was lower for the tendency of accidents than the violations, probably because committing traffic violations was self-determined; in contrast, the collision occurrence was more or less related to the riders' own or other road users' carelessness. The RSC could be more effective if a certification test for road safety education were required or if a penalty is imposed on distracted learners during the training.

The impact of global budgeting on treatment intensity and outcomes.

This paper investigates the effects of global budgets on the amount of resources devoted to cardio-cerebrovascular disease patients by hospitals of different ownership types and these patients' outcomes. Theoretical models predict that hospitals have financial incentives to increase the quantity of treatments applied to patients. This is especially true for for-profit hospitals. If that's the case, it is important to examine whether the increase in treatment quantity is translated into better treatment outcomes. Our analyses take advantage of the National Health Insurance of Taiwan's implementation of global budgets for hospitals in 2002. Our data come from the National Health Insurance's claim records, covering the universe of hospitalized patients suffering acute myocardial infarction, ischemic heart disease, hemorrhagic stroke, and ischemic stroke. Regression analyses are carried out separately for government, private not-for-profit and for-profit hospitals. We find that for-profit hospitals and private not-for-profit hospitals did increase their treatment intensity for cardio-cerebrovascular disease patients after the 2002 implementation of global budgets. However, this was not accompanied by an improvement in these patients' mortality rates. This reveals a waste of medical resources and implies that aggregate expenditure caps should be supplemented by other designs to prevent resources misallocation.

Improvement of quality of life in methadone treatment patients in northern Taiwan: a follow-up study.

BACKGROUND: This study examined long-term improvement of quality of life amongst heroin users enrolled in methadone maintenance treatment (MMT). METHODS: The sample contained 553 heroin-dependent individuals from 4 hospitals in northern Taiwan who enrolled in MMT for an average of 184 days. Each patient signed a consent form and was assessed prospectively 3 times semi-annually. Quality of life was measured using the WHOQOL-BREF questionnaire, 26 items of which were scored by the participants. The WHOQOL-BREF consists of four domains: physical, psychological, social, and environmental. 285 and 155 participants completed 6-month and 12-month follow-ups respectively. RESULTS: After controlling for demographic and clinical characteristics, there were statistically significant improvements in the psychological and environmental domains between baseline and 6 months. Significant improvements were found in psychological and social domains between baseline and 12 months. CONCLUSIONS: It is concluded that methadone maintenance treatment improves heroin users' long-term quality of life in the psychological and social relationship domains.

Obesity and risk knowledge.

Obesity is an epidemic health problem in many developed countries, and it is an emerging public health concern in developing, transitional, and newly developed countries. The purpose of this research is to investigate the relationship between individuals' knowledge concerning the health risks of obesity and their tendency to be obese (as measured by the "body mass index"). Instead of assuming that obesity is a pure physiological problem as in previous studies, we allow an individual's cost/benefit evaluation to play a role. Based on survey data from Taiwan, we investigate the relationship with the quantile regression technique. The results suggest that such a relationship does exist and it is different for males and females.