Nonemergent emergency department visits under the National Health Insurance in Taiwan

Tsai, Jeffrey Che-Hung; Chen, Wenyi; Liang, Yia-Wun

doi:10.1016/j.healthpol.2010.10.007

Cited by 32 publications

(23 citation statements)

References 32 publications

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“…; Ben‐Isaac et al. ; Tsai, Chen, and Liang ). This algorithm (recently validated) uses the ICD9‐CM international diagnosis code to determine the probability of an ED visit to be a nonemergency, a primary care treatable emergency, a preventable or avoidable emergency, or a nonpreventable or avoidable emergency (Ballard et al.…”

Section: Discussionmentioning

confidence: 99%

The Burden of Inappropriate Emergency Department Pediatric Visits: Why Italy Needs an Urgent Reform

Vedovetto¹,

Soriani

Merlo

et al. 2014

Health Services Research

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Objective. To better understand the issue of inappropriate pediatric Emergency Department (ED) visits in Italy, including the impact of the last National Health System reform. Study Design. A retrospective cohort study was conducted with five health care providers in the Veneto region (Italy) in a 2-year period (2010)(2011). ED visits were considered "inappropriate" by evaluating both nursing triage and resource utilization, as addressed by the Italian Ministry of Health in 2007. Factors associated with inappropriate ED visits were identified. The cost of each visit was calculated. Principal Findings. In total, 134,358 ED visits with 455,650 performed procedures were recorded in the 2-year period; of these, 76,680 (57.1 percent) were considered inappropriate ED visits. Patients likely to make inappropriate ED visits were younger, female, visiting the ED during night or holiday, when the primary care provider (PCP) is not available. Conclusion. The National Health System reform aims to improve efficiency, effectiveness, and costs by opening PCP offices 24 hours a day and 7 days a week. This study highlights the need for a deep reorganization of the Italian Primary Care System not only providing a larger time availability but also treating the parents' lack of education on children's health. Key Words. Nonurgent, inappropriate, pediatric emergency department, health expenditure, reorganizationThe aim of the Emergency Department (ED) is to address emergent or urgent health problems, whose treatment has to be immediate. ED utilization is continuously rising (Ben-Isaac et al. 2010): in the United States the number of visits increased from 96 million in 1995 to 119 million in 2006. Patients from 0 to 18 years of age account for about 25 percent of the total number of ED visits (Mistry et al. 2006). The high level of utilization of ED services is overwhelmed by an inappropriate and heavy access for nonurgent conditions. The

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Section: Discussionmentioning

confidence: 99%

The Burden of Inappropriate Emergency Department Pediatric Visits: Why Italy Needs an Urgent Reform

Vedovetto¹,

Soriani

Merlo

et al. 2014

Health Services Research

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“…A published report by Tsai et al analyzes ambulatory visit data in Taiwan for 2002 and demonstrates that approximately 35% of emergency care cases are non-emergency visits or an emergency that is preventable with primary care [28]. After subtracting possible non-emergency cases among the enrolled, the hospitalization rate for real emergency visits in children in Taiwan seems to be about 6.7%, which is still lower than that in the United States.…”

Section: Discussionmentioning

confidence: 99%

A 10-year population-based nationwide descriptive analysis of pediatric emergency care

et al. 2014

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BackgroundPediatric emergency care medicine is an important field of health care. This study aimed to investigate the 10-year pediatric emergency care in children aged 0-17 years old in Taiwan.MethodsSystematic random samples from the National Health Insurance Research Database of Taiwan in the period 2000-2009 were analyzed. Children recorded as undergoing emergency care were enrolled and divided into different age groups. The frequency of emergency visits, age, cost per visit, seasonality, number of hospitalizations, and diagnosis were analyzed.ResultsA total of 764,598 children were enrolled. These children accounted for 25% of all emergency cases and their mean age was 6.1 years. Children aged 0-5 years formed the largest group, with male predominance (57.5%). The incidence of emergency visits was 29133 ± 3104 per 100,000 children per year (mean ± SD). Acute upper airway infection, fever, and acute gastrointestinal illness were the most common diagnoses among all non-hospitalized children. Some (4.51%) required subsequent hospitalization and their most common diagnoses were fluid/electrolyte disorder, upper/lower airway infection, and acute gastrointestinal illness. The group of children aged 12-17 years had cases of traumatic injury and childbirth.ConclusionsIn Taiwan, 25% of individuals seeking emergency care are children, mostly aged 0-5 years old. Costs and disease patterns vary among different age groups. Preventive measures targeting all children should focus on respiratory and gastrointestinal diseases, but should target different diseases for different age groups to improve child health.

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“…As one of the largest and most comprehensive national-level population databases in the world, 29 the NHI Database contains healthcare records of 30 million residents of Taiwan, including inpatient, outpatient, and pharmacy services. 30 The NHI Database is ideal for longitudinal epidemiological investigation because each beneficiary of the NHI has a unique identification number consistent across all datasets, and can be followed through multiple clinical encounters. 31 To maximally retain the population heterogeneity to reflect the real-world impact of SES, we selected a random 25% sample from the eligible adult population in 2000 from the NHI Database by random sampling method based on Floyd's ordered hash table algorithm to ensure an equal probability of the eligible population being selected.…”

Section: Data Sourcementioning

confidence: 99%

“…Demographic and clinical covariates included in the analysis were patients' sex, age, income level, occupation type, urbanization of area of residence, number of outpatient visits, number of hospital admissions, and the physician density of the area of patients' residence. Occupation categories defined by the NHI program enrollment protocol 30 and income levels in Taiwan dollars were collected directly from the NHI Database and were converted to US dollars by the mean exchange rate during each corresponding calendar year. 36 We compared demographic characteristics by income groups for each time wave by analysis of variance test and chi-squared test.…”

Section: Variables Of Interestmentioning

confidence: 99%

Investigating the Causal Effect of Socioeconomic Status on Quality of Care under a Universal Health Insurance System – A Marginal Structural Model Approach

Cho

Wang

Chen

et al. 2019

Preprint

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Background: Social disparities in healthcare persist in the US despite the expansion of Medicaid under the Affordable Care Act. We investigated the causal impact of socioeconomic status on the quality of care in a setting with minimal confounding bias from race, insurance type, and access to care. Methods: We designed a retrospective population-based study with a random 25% sample of adult Taiwan population enrolled in Taiwan’s National Health Insurance system from 2000 to 2016. Patient’s income levels were categorized into low-income group (<25th percentile) and high-income group (≥25th percentile). We used marginal structural modeling analysis to calculate the odds of hospital admissions for 11 ambulatory care sensitive conditions identified by the Agency for Healthcare Research and Quality and the odds of having an Elixhauser comorbidity index greater than zero for low-income patients. Results: Among 2,844,334 patients, those in lower-income group had 1.28 greater odds (95% CI 1.24 – 1.33) of experiencing preventable hospitalizations, and 1.04 greater odds (95% CI 1.03 – 1.05) of having a comorbid condition in comparison to high-income group. Conclusions: Income was shown to be a causal factor in a patient’s health and a determinant of the quality of care received even with equitable access to care under a universal health insurance system. Policies focusing on addressing income as an important upstream causal determinant of health to provide support to patients in lower socioeconomic status will be effective in improving health outcomes for this vulnerable social stratum.

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Nonemergent emergency department visits under the National Health Insurance in Taiwan

Cited by 32 publications

References 32 publications

The Burden of Inappropriate Emergency Department Pediatric Visits: Why Italy Needs an Urgent Reform

The Burden of Inappropriate Emergency Department Pediatric Visits: Why Italy Needs an Urgent Reform

A 10-year population-based nationwide descriptive analysis of pediatric emergency care

Investigating the Causal Effect of Socioeconomic Status on Quality of Care under a Universal Health Insurance System – A Marginal Structural Model Approach

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