RESUMO
BACKGROUND: This study aimed to investigate the risk of attempted suicide in the population of patients diagnosed with peripheral vestibular disorders (PVD). METHODS: We conducted a retrospective cohort study. We extracted data on patients diagnosed with PVD (72,569 study patients) and a 3:1 ratio of propensity-score matched comparison patients without PVD (217,707 patients) from Taiwan's Longitudinal Health Insurance Database 2010. The claims records of sampled patients were tracked for a one-year period from their index date to identify claims showing a diagnosis of suicide attempt. Cox proportional hazards regression analyses were performed to calculate the one-year hazard ratio (HR) of suicide attempt following the PVD diagnosis among PVD patients relative to comparison patients. RESULTS: Of total 290,276 sampled patients, the rate of attempted suicide was 0.158 per 100 person-years, being 0.460 and 0.057, respectively, among PVD patients and comparison patients. Cox proportional hazard analysis showed that PVD patients had a high relative hazard of suicide attempt (adjusted HR = 7.622, 95 % CI = 6.196-9.376) during one-year follow-up relative to comparison patients. We also found that subcategories of PVD, showed similar adjusted hazard ratios as all PVDs: Meniere's disease (HR = 7.608, 95 % CI = 4.350-13.305), benign paroxysmal positional vertigo (HR = 8.201, 95 % CI = 4.716-14.260), and vestibular neuritis (HR = 9.399, 95 % CI = 5.036-17.544). LIMITATIONS: The incidence of suicide attempts could be underestimated in both the study group and comparison group, if the suicide attempt did not cause a medical emergency and the patient did not seek medical assistance. CONCLUSIONS: We found a high magnitude of association between PVD and subsequent suicide attempt.
Assuntos
Seguro Saúde , Tentativa de Suicídio , Humanos , Estudos Retrospectivos , Bases de Dados Factuais , Pontuação de PropensãoRESUMO
OBJECTIVE: To examine the impact of provider competition under global budgeting on the use of cesarean delivery in Taiwan. DATA SOURCES/STUDY SETTING: (1) Quarterly inpatient claims data of all clinics and hospitals with birth-related expenses from 2000 to 2008; (2) file of health facilities' basic characteristics; and (3) regional quarterly point values (price conversion index) for clinics and hospitals, respectively, from the fourth quarter in 1999 to the third quarter in 2008, from the Statistics of the National Health Insurance Administration. STUDY DESIGN: Panel data of quarterly facility-level cesarean delivery rates with provider characteristics, birth volumes, and regional point values are analyzed with the fractional response model to examine the effect of external price changes on provider behavior in birth delivery services. PRINCIPAL FINDINGS: The decline in de facto prices of health services as a result of noncooperative competition under global budgeting is associated with an increase in cesarean delivery rates, with a high degree of response heterogeneity across different types of provider facilities. CONCLUSIONS: While global budgeting is an effective cost containment tool, intensified financial pressures may lead to unintended consequences of compromised quality due to a shift in provider practice in pursuit of financial rewards.
Assuntos
Orçamentos/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Controle de Custos/estatística & dados numéricos , Competição Econômica/estatística & dados numéricos , Adulto , Fatores Etários , Cesárea/economia , Controle de Custos/métodos , Competição Econômica/economia , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Taiwan , Adulto JovemRESUMO
Driving under the influence (DUI) is one of the major causes of traffic accidents in Taiwan. About 5% of injuries involve DUI, and nearly 20% of deaths are due to alcohol-related crashes. During early 2006 to the end of 2014, the authorities in Taiwan increased the severity of fine and jail penalties for DUI offenders three times. At the same time, the monthly drunk-driving injures decreased nearly 40% and the monthly alcohol-related traffic death dropped more than 80%. In this paper, we examine the effects of sanction changes on the reduction of drunk-driving casualties during this period. We find that drunk-driving injuries and deaths significantly dropped after the statutory changes. The reduction was immediate following all sanction changes that raised the maximum fines or jail terms of DUI offenders. Policies that increased the maximum jail terms of DUI offenders seem to have a better gradual effect on the reduction of alcohol-related traffic casualties. Although increased sanctions are found to be effective in reducing drunk-driving casualties, we need more future research to examine the policy-to-perception and the policy-to-behavior links.
Assuntos
Acidentes de Trânsito/prevenção & controle , Dirigir sob a Influência/legislação & jurisprudência , Controle Social Formal/métodos , Acidentes de Trânsito/mortalidade , Dirigir sob a Influência/prevenção & controle , Dirigir sob a Influência/estatística & dados numéricos , Humanos , Modelos Logísticos , Taiwan/epidemiologia , Fatores de Tempo , Ferimentos e Lesões/epidemiologiaRESUMO
This study is the first comprehensive analysis to investigate the potential association between stock market fluctuations and attempted suicide events as measured by self-inflicted injuries treated in hospitalization. Using nationwide, 15-year population-based data from 1998 through 2012, we observe that the occurrences for the hospitalizations of attempted suicides are apparently predicted by stock price movements. A low stock price index, a daily fall in the stock index, and consecutive daily falls in the stock index have been shown to be associated with increased risk of hospitalization in patients with attempted suicide. More specifically, stock price index is found to be significant impact on attempted suicide in the 45-54 age groups of both genders, whilst daily change is significant for both genders in the 25-34 and 55-64 age groups and accumulated change is only significant in female aged 25-44 and above 65. On the basis of the results, relevant organizations should consider the suicidal factors that relate prime-working-age and near-retirement-age people to better carry out specific suicide prevention measures, and, meanwhile, encourage those people to pay less attention towards daily stock price movements.
Assuntos
Comércio , Economia , Tentativa de Suicídio/psicologia , Adulto , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , TaiwanRESUMO
This paper investigates the relationship between the stock market and the neurotic disorder doctor visits. We use aggregate data, partition the population by age and gender and examine the impact of changes in the stock market on neurotic disorders. Using doctor visits as a proxy measure of morbidity, we find evidence of some relationship between neurotic disorder morbidity and stock market variations. A stock market falling in a single day and the accumulation of daily stock market drops are both associated with more neurotic disorder doctor visits. We also observe more neurotic disorder doctor visits during periods of a low stock index for the elderly, regardless of gender. Copyright © 2016 John Wiley & Sons, Ltd.
Assuntos
Economia/estatística & dados numéricos , Transtornos Neuróticos/psicologia , Visita a Consultório Médico/estatística & dados numéricos , Estresse Psicológico/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Taiwan , Fatores de TempoRESUMO
Using 10-year population data from 2000 through 2009 in Taiwan, this is the first paper to analyze the relationship between margin trading in stock markets and stroke hospitalizations. The results show that 3 and 6 days after an increase of margin trading in the Taiwan stock markets are associated with greater stoke hospitalizations. In general, a 1 % increase in total margin trading positions is associated with an increment of 2.5 in the total number of stroke hospitalizations, where the mean number of hospital admissions is 233 cases a day. We further examine the effects of margin trading by gender and age groups and find that the effects of margin trading are significant for males and those who are 45-74 years old only. In summary, buying stocks with money you do not have is quite risky, especially if the prices of those stocks fall past a certain level or if there is a sudden and severe drop in the stock market. There is also a hidden danger to one's health from margin trading. A person should be cautious before conducting margin trading, because while it can be quite profitable, danger always lurks just around the corner.
Assuntos
Investimentos em Saúde/estatística & dados numéricos , Assunção de Riscos , Acidente Vascular Cerebral/epidemiologia , Adulto , Fatores Etários , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/etiologia , Taiwan/epidemiologiaRESUMO
Whether provision of free preventive care for the elderly under National Health Insurance has reduced the risk for curative care use raises much concern in Taiwan. This study analyzes the relationship by examining the impact of health examination utilization on the utilizations of outpatient care and inpatient care. Data come from the 2005 National Health Interview Survey and National Health Insurance Research Database. A two-stage method is used in the estimation. We found a negative relationship between the utilization of preventive care and hospitalization care in terms of length of stay and medical expenditures. On average, the elderly people who used preventive care tended to have 16 shorter hospitalization stays and NTD64,220 lower hospitalization expenditures than their counterparts. In order to improve the health of the elderly and reduce the escalation of medical expenditures due to aging, including preventive care in the health insurance is a very effective strategy.
Assuntos
Assistência Ambulatorial/economia , Custos de Cuidados de Saúde , Hospitalização/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Acessibilidade aos Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Fatores de Risco , TaiwanRESUMO
This is the first research to examine a potential relation between stock market volatility and mental disorders. Using data on daily incidences of mental disorders in Taiwan over 4000 days from 1998 through 2009 to assess the time-series relation between stock price movements and mental disorders, we observe that stock price fluctuation clearly affects the hospitalization of mental disorders. We find that during a 12-year follow-up period, a low stock price index, a daily fall in the stock price index and consecutive daily falls in the stock price index are all associated with greater of mental disorders hospitalizations. A 1000-point fall in the TAIEX (Taiwan Stock Exchange Capitalization Weighted Stock Index) increases the number of daily mental disorders hospitalizations by 4.71%. A 1% fall in the TAIEX in one single day increases daily hospitalizations for mental disorders by 0.36%. When the stock price index falls one consecutive day, it causes a daily increase of approximately 0.32% hospitalizations due to mental disorders on that day. Stock price index is found to be significant for both gender and all age groups. In addition, daily change is significant for both gender and middle-age groups, whereas accumulated change is significant for males and people aged 45-64. Stockholdings can help people accumulate wealth, but they can also increase mental disorders hospitalizations. In other words, stock price fluctuations do drive people crazy.
Assuntos
Economia/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Adulto , Fatores Etários , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/etiologia , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos , Taiwan/epidemiologiaRESUMO
Two policy interventions in Taiwan aiming to slow the growth of cesarean delivery utilization were respectively implemented in 2005 and 2006. The first policy provided financial incentives to encourage vaginal delivery by setting a global fee for obstetric services and in essence increasing the reimbursement for vaginal delivery up to the same level of cesarean section. The second policy aimed to reduce the demand for elective cesarean procedure by employing a copayment when cesarean section is not medically indicated. This paper examines the impact of financial incentives of both the supply and the demand side on the use of utilization of cesarean section using data from the 2003-2008 National Health Insurance Research Database. We found that while the overall trend of cesarean utilization did not seem to respond to the interventions, the policies did have significant impact on its elective use. Financial incentives for the providers do matter, and policy interventions, such as a fee change, are still important strategies to consider in reducing the over-utilization of cesarean section.
Assuntos
Cesárea/estatística & dados numéricos , Política de Saúde , Reembolso de Incentivo , Cesárea/economia , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Honorários e Preços , Feminino , Humanos , Gravidez , TaiwanRESUMO
OBJECTIVE: The purpose of the study is to examine whether women who have undergone cesarean deliveries on maternal request (CDMR) have a higher utilization of outpatient and inpatient obstetric and gynecological services than do those with vaginal deliveries (VD). METHODS: We use two population-based claims datasets to trace the six-month, one-year, and two-year postpartum periods (PP) medical care utilizations by women who have undergone CDMRs or VDs during 2002 in Taiwan. The paper analyses the utilization of services through logistic, negative binomial, linear, and log-linear regressions based on the data types. RESULTS: We find that CDMRs are associated with a greater utilization of medical care than are VDs. Compared to mothers who have undergone VDs, those who underwent CDMRs have a greater likelihood to have additional outpatient visits (by 9.6% for six-month PP and 7.5% for one-year PP) and re-hospitalization (by 0.24%, 0.3%, and 0.66% for the three PPs, respectively), more outpatient revisits (by 0.47, 0.66, and 1.07, respectively), greater outpatient expenditure (by NT$324 for one-year PP) and inpatient expenditure (by NT$6178, NT$5992, and NT$5484, respectively). CONCLUSION: Cesarean deliveries on maternal request lead to significant negative outcomes during the postpartum period, which should be taken into account in the cost-benefit calculation.
Assuntos
Cesárea/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos , Serviços de Saúde Materna/estatística & dados numéricos , Adulto , Cesárea/economia , Feminino , Humanos , Revisão da Utilização de Seguros , Serviços de Saúde Materna/economia , Período Pós-Parto , Gravidez , Resultado da Gravidez , Taiwan , Adulto JovemRESUMO
This paper investigates the impact of stock market movement on incidences of stroke utilizing population-based aggregate data in Taiwan. Using the daily data from the Taiwan Stock Exchange Capitalization Weighted Stock Index and from the National Health Insurance Research Database during 2001/1/1-2007/12/31, which consist of 2556 observations, we examine the effects of stock market on stroke incidence - the level effect and the daily change effects. In general, we find that both a low stock index level and a daily fall in the stock index are associated with greater incidences of stroke. We further partition the data on sex and age. The level effect is found to be significant for either gender, in the 45-64 and 65 ≥ age groups. In addition, two daily change effects are found to be significant for males and the elderly. Although stockholdings can increase wealth, they can also increase stroke incidence, thereby representing a cost to health.
Assuntos
Investimentos em Saúde/economia , Acidente Vascular Cerebral/epidemiologia , Idoso , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taiwan/epidemiologiaRESUMO
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.
Assuntos
Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde/estatística & dados numéricos , Pacientes Internados , Medicina Preventiva , Idoso , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , TaiwanRESUMO
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$2811 (US$73.6) vs. NT$2570 (US$71.4)]. The likelihood of postpartum outpatient visits taking place within the 6-month postdelivery period was also slightly higher for elective CS than for vaginal deliveries (77% vs. 70%). The regression results showed that elective CS was associated with significantly higher utilization of maternal medical care compared with vaginal deliveries. CONCLUSIONS: Although the difference between elective CS and vaginal deliveries in terms of postpartum medical care utilization is statistically significant, the small magnitude of the difference in cost (NT$72; US$2.2) suggests that it may not be clinically significant, and may only be marginally important from a policy perspective.
Assuntos
Cesárea , Procedimentos Cirúrgicos Eletivos , Serviços de Saúde Materna/estatística & dados numéricos , Período Pós-Parto , Adulto , Feminino , Custos de Cuidados de Saúde , Humanos , Serviços de Saúde Materna/economiaRESUMO
OBJECTIVE: To examine the relationship between obstetrician gender and the likelihood of maternal request for cesarean section (CS) within different healthcare institutions (medical centers, regional hospitals, district hospitals, and obstetric and gynecology clinics). STUDY DESIGN: Five years of population-based data from Taiwan covering 857,920 singleton deliveries without a clinical indication for a CS were subjected to a multiple logistic regression to examine the association between obstetrician gender and the likelihood of maternal request for a CS. RESULTS: After adjusting for physician and institutional characteristics, it was found that male obstetricians were more likely to perform a requested CS than female obstetricians in district hospitals (OR=1.53) and clinics (OR=2.26), while obstetrician gender had no discernible associations with the likelihood of a CS upon maternal request in medical centers and regional hospitals. CONCLUSIONS: While obstetrician gender had the greatest association with delivery mode decisions in the lowest obstetric care units, those associations were diluted in higher-level healthcare institutions.
Assuntos
Cesárea , Obstetrícia , Fatores Sexuais , Instituições de Assistência Ambulatorial , Feminino , Hospitais Públicos , Hospitais Filantrópicos , Humanos , Modelos Logísticos , Masculino , Satisfação do Paciente , Gravidez , Setor Privado , Probabilidade , Fatores Socioeconômicos , TaiwanRESUMO
OBJECTIVES: To explore the association between the place of death and the level of urbanization within the communities where the elderly were residing at the time of their death. METHODS: A retrospective, population-based, cross-sectional study set in Taiwan, involving a total of 697,814 eligible deaths occurred between 1995 and 2004, among elderly people (aged 65 years or above). RESULTS: After adjusting for other factors, the multilevel logistic regression analyses showed that home death was associated with lower levels of urbanization; as compared with participants living in the highest urbanization level (level 1), the respective adjusted odds of dying at home were 1.600, 2.769, 3.774, 4.481, 4.003 and 4.717 times for those living in the areas from the second highest to the lowest urbanization levels (levels 2-7). CONCLUSIONS: After adjusting for other socio-demographic, clinical and healthcare factors, the place of death has a significant association with the level of urbanization among the elderly.
Assuntos
Atitude Frente a Morte , Serviços de Assistência Domiciliar/estatística & dados numéricos , Urbanização , Idoso , Idoso de 80 Anos ou mais , Fatores Epidemiológicos , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Taiwan/epidemiologia , Taiwan/etnologia , Doente TerminalRESUMO
BACKGROUND: Taiwan has a high rate of cesarean section, approximately 33 percent in the past decade. This study investigates and discusses 2 possible factors that may encourage the practice, one of which is fetal gender difference and the other is Taiwan's recently implemented National Health Insurance (NHI). METHODS: A logistic regression model was used with the 1989 and 1996 National Maternal and Infant Health Survey and with the 2001 to 2003 NHI Research Databases. RESULTS: Using survey data, we found a statistically significant 0.3 percent gender difference in parental choice for cesarean section. However, no statistically significant difference was found in the rate of cesarean section before and after NHI implementation. CONCLUSIONS: Taiwan's high cesarean section rate is not directly related to financial incentives under NHI, indicating that adjusting policy to lower financial incentives from NHI would have only limited effect. Likewise, focusing effort on the small gender difference is unlikely to have much impact. Effective campaigns by health authorities might be conducted to educate the general population about risks associated with cesarean section and the benefits of vaginal birth to the child, mother, and society.
Assuntos
Cesárea/economia , Cesárea/estatística & dados numéricos , Identidade de Gênero , Política de Saúde , Bem-Estar do Lactente/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Adulto , Cesárea/tendências , Características Culturais , Tomada de Decisões , Feminino , Educação em Saúde/organização & administração , Humanos , Recém-Nascido , Cobertura do Seguro , Modelos Logísticos , Gravidez , Cuidado Pré-Natal/organização & administração , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Taiwan/epidemiologiaRESUMO
This study aims to examine the impact of length of stay, hospital characteristics, physician characteristics and other factors on the expenditures of hospitalization for acute myocardial infarction (AMI) under Taiwan's National Health Insurance program. This study uses data collected from the Taiwan's National Health Research Institute's 2001-2003 National Health Insurance Research Database. We estimated contributors to increased expenditures of hospitalization using three-stage least square regression model. The hospital expenditures for the treatment of AMI averaged NT$126,366 (US$3829, US$1=NT$33) per discharge, with the largest proportion (27%) spent on room expenditures. They were strongly impacted by length of stay, increasing around 4.8% per day. We conclude that hospital expenditures for the treatment of AMI patients may vary widely depending on the characteristics of the hospital and physicians that provide them care.
Assuntos
Gastos em Saúde , Hospitais/estatística & dados numéricos , Tempo de Internação/economia , Infarto do Miocárdio/economia , Médicos/estatística & dados numéricos , Adulto , Bases de Dados como Assunto , Feminino , Humanos , Masculino , Medicina/estatística & dados numéricos , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Análise de Regressão , Especialização , Taiwan/epidemiologiaRESUMO
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.
Assuntos
Planejamento em Saúde Comunitária , Tempo de Internação/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Esquizofrenia/epidemiologia , Adulto , Distribuição por Idade , Análise de Variância , Grupos Diagnósticos Relacionados , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Unequal geographical distribution of medical care resources and insufficient healthcare coverage have been two long-standing problems with Taiwan's 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 Taiwan's National Health Insurance (NHI) has reduced out-of-pocket medical expenditures in households in different regions and varying levels of income. METHODS: Data 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. RESULTS: An 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. CONCLUSION: Although 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.
Assuntos
Financiamento Pessoal/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Adulto , Idoso , Área Programática de Saúde , Coleta de Dados , Pesquisa Empírica , Características da Família , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/normas , Análise de Regressão , Fatores Socioeconômicos , TaiwanRESUMO
The effect of raising cigarette taxes to reduce smoking has been the subject of several studies, which often treat the price of cigarettes as an exogenous factor given to smokers who respond to it by adjusting their smoking behavior. However, cigarette prices vary with brand and quality, and smokers can and do switch to lower-priced brands to reduce the impact of the tax on the cost of cigarettes as they try to consume the same number of cigarettes as they had before a tax hike. Using data from a two-year follow-up interview survey conducted before and after a new cigarette tax scheme was imposed in Taiwan in 2002, this study examines three behavioral changes smokers may make to respond to tax-induced cigarette price increase: brand-switching, amount consumed, and amount spent on smoking. These changes were studied in relation to smoker income, before-tax cigarette price, level of addiction, exposure to advertizing, and consumer loyalty. We found that smokers, depending upon exposure to advertizing, level of consumer loyalty and initial price of cigarettes, switched brands to maintain current smoking habits and control costs. We also found that the initial amount smoked and level of addiction, not price, at least not at the current levels in Taiwan, determined whether a smoker reduced the number of cigarettes he consumed.