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Habte A, Tamene A, Melis T. Compliance towards WHO recommendations on antenatal care for a positive pregnancy experience: Timeliness and adequacy of antenatal care visit in Sub-Saharan African countries: Evidence from the most recent standard Demographic Health Survey data. PLoS One 2024; 19:e0294981. [PMID: 38271342 PMCID: PMC10810464 DOI: 10.1371/journal.pone.0294981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 11/14/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Timely and adequate antenatal care (ANC) visits are known to reduce maternal mortality by 20%. Despite the World Health Organization updating its recommendations from four to eight antenatal care contacts, data reporting in the SSA region focused primarily on four visits, and evidence on the timing and adequacy of ANC based on the current recommendation was limited. Hence, this study aimed at assessing the level of timely and adequate ANC visits and their determinants in the 18 Sub-Saharan African countries with the most recent DHS report (2016-2021). METHODS The data for this study were pooled from the most recent standardized Demographic and Health Survey data of sub-Saharan African countries from 2016-2021. A total of 171,183 (with a weighted frequency of 171,488) women were included and analyzed by using STATA version 16. To account for data clustering, a multivariable multilevel mixed-effect logistic regression analysis was run to determine the effects of each predictor on the receipt of timely and adequate ANC. Adjusted odds ratio with its corresponding 95% confidence interval was used to declare the statistical significance of the independent variables. RESULTS The receipt of timely and adequate antenatal care visits was 41.2% (95% CI: 40.9, 41.4) and 10.4% (95% CI: 9.9, 10.2), respectively. Wontedness of pregnancy [AOR = 1.18; 95% CI: 1.13, 1.24], being 1st birth order [AOR = 1.48; 95% CI: 1.41, 2.54], having a mobile phone [AOR = 1.49; 95% CI: 1.26, 2.32], and enrolled in Health insurance schemes [AOR = 2.03; 95% CI: 1.95, 2.42] were significantly associated with early initiation of ANC. Living in a lower community poverty level[AOR = 2.23; 95% CI: 1.90,2.66], being in the richest wealth quintile [AOR = 1.49; 95% CI: 1.36, 1.62], higher educational level [AOR = 3.63; 95% CI: 3.33, 3.96], the timing of ANC visit [AOR = 4.26; 95% CI: 4.08, 4.44], being autonomous in decision making [AOR = 2.29; 95% CI: 1.83, 2.54] and having a mobile phone [AOR = 1.89; 95% CI: 1.76, 2.52] were identified as significant predictors of adequate ANC uptake. CONCLUSION The findings revealed a low coverage of timely and adequate ANC visits in SSA countries. Governments and healthcare managers in sub-Saharan African countries should leverage their efforts to prioritize and implement activities and interventions that increase women's autonomy, and economic capability, to improve their health-seeking behavior during pregnancy. More commitment is needed from governments to increase mobile phone distribution across countries, and then work on integrating mHealth into their health system. Finally, efforts should be made to increase the coverage of health insurance schemes enrolment for the citizens.
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Affiliation(s)
- Aklilu Habte
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Aiggan Tamene
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Tamirat Melis
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
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Chen YL, Tseng CH, Cheong ML, Lien YJ, Wang SH, Chang CM, Liao SC, Wu CS. Associations between antenatal education program and mental health outcomes in Taiwan: A population-based cohort study. Psychiatry Res 2023; 322:115128. [PMID: 36870316 DOI: 10.1016/j.psychres.2023.115128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/04/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
Universal antenatal education has been offered to expectant mothers in Taiwan since 2014. Depression screening is included in the offered education sessions. This study aimed to examine the association of antennal education and depression screening with mental health outcomes, including perinatal depression diagnosis and psychiatrist visits. Data was obtained from the antenatal education records and Taiwan's National Health Insurance claims database. A total of 789,763 eligible pregnant women were included in the current study. The psychiatric-related outcomes were measured between antenatal education and the six-month after delivery. It was found that the antenatal education was widely used in Taiwan, and the attendance rate has increased to 82.6% since its launch. The attenders were more likely to be from disadvantaged backgrounds, and 5.3% of them were screened positive for depressive symptoms. They were also more likely to visit a psychiatrist but less likely to be diagnosed with depression than the non-attenders. Factors including young age, high healthcare utilization, and comorbid psychiatric disorder history were consistently associated with depression symptoms, perinatal depression diagnoses and psychiatrist visits. Further research is needed to understand the reasons for the nonattendance at antenatal education programmes and the barriers to utilizing mental health services.
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Affiliation(s)
- Yu-Ling Chen
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan; Department of Physical Education, National Taiwan University of Sport, Taichung City, Taiwan
| | - Ching-Hsuan Tseng
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan
| | - Mei-Leng Cheong
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
| | - Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Shi-Heng Wang
- College of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Ming Chang
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Yunlin branch, Douliu, Taiwan.
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Chen MM, Cheng BH. Understanding Taiwanese Women's Decisional Experiences Regarding Prenatal Screening Procedures And Diagnostics: A Phenomenological Study. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:231-240. [PMID: 32835863 DOI: 10.1016/j.anr.2020.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/20/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study sought to understand Taiwanese women's decisional experiences regarding prenatal screening procedures and diagnostics. METHODS A hermeneutic phenomenological design guided semistructured interviews with 33 women who were 36 weeks pregnant. Data were collected between February and October 2016. Verbatim transcripts were analyzed following hermeneutic circle to cocreate an understanding of Taiwanese women's decision-making in prenatal screening and diagnostics. RESULTS Women's existential experiences were derived from their decision-making process on prenatal screening procedures and diagnostics for chromosomal aneuploidy. These decisional experiences were captured by four theme clusters and eight themes, which were inductively derived from 16 meaning units: (1) accessing health information; (2) considering what was best for my baby; (3) considering family finance; and (4) feeling anxiety posttest. CONCLUSION Participants made informed choices on several prenatal screening procedures, ostensibly, based on their personal values and considerations. During the decision-making process, often-cited benefits of genetic screenings were emphasized, but test limitations were often unheeded. A fundamental need for supportive information in decision making was further identified with recommended strategies. Hence, a revision of traditional genetic counseling approaches is recommended. As genomics technologies are increasingly available during antenatal services, women should be sufficiently educated about them to support decision making.
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Affiliation(s)
- Mei-Man Chen
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
| | - Bi-Hua Cheng
- Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
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Gaffney A, Woolhandler S, Himmelstein D. The Effect of Large-scale Health Coverage Expansions in Wealthy Nations on Society-Wide Healthcare Utilization. J Gen Intern Med 2020; 35:2406-2417. [PMID: 31745857 PMCID: PMC7403378 DOI: 10.1007/s11606-019-05529-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/25/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
Most analysts project that a reform like Medicare-for-All that lowers financial barriers to care would cause a surge in the utilization of services, raising costs despite stable or even reduced prices. However, the finite supply of physicians and hospital beds could constrain such utilization increases. We reviewed the effects of 13 universal coverage expansions in capitalist nations on physician and hospital utilization, beginning with New Zealand's 1938 Social Security Act up through the 2010 Affordable Care Act in the USA. Almost all coverage expansions had either a small (i.e., < 10%) or no effect on society-wide utilization. However, coverage expansions often redistributed care-increasing use among newly covered groups while producing small, offsetting reductions among those already covered. We conclude that in wealthy nations, large-scale coverage expansions need not cause overall utilization to surge if provider supply is controlled. However, such reforms could redirect care towards patients who most need it.
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Affiliation(s)
- Adam Gaffney
- Harvard Medical School, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02138 USA
| | - Steffie Woolhandler
- Harvard Medical School, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02138 USA
- City University of New York at Hunter College, New York, USA
| | - David Himmelstein
- Harvard Medical School, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA 02138 USA
- City University of New York at Hunter College, New York, USA
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Wang W, Temsah G, Mallick L. The impact of health insurance on maternal health care utilization: evidence from Ghana, Indonesia and Rwanda. Health Policy Plan 2017; 32:366-375. [PMID: 28365754 PMCID: PMC5400062 DOI: 10.1093/heapol/czw135] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 12/14/2022] Open
Abstract
While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage-Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care.
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Affiliation(s)
- Wenjuan Wang
- International Health and Development Division, ICF International, Rockville, MD, USA
| | - Gheda Temsah
- International Health and Development Division, ICF International, Rockville, MD, USA
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Park HJ, Lee JH, Park S, Kim TI. Changes in dental care access upon health care benefit expansion to include scaling. J Periodontal Implant Sci 2016; 46:405-414. [PMID: 28050318 PMCID: PMC5200866 DOI: 10.5051/jpis.2016.46.6.405] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 11/22/2016] [Indexed: 11/08/2022] Open
Abstract
Purpose This study aimed to evaluate the effects of a policy change to expand Korean National Health Insurance (KNHI) benefit coverage to include scaling on access to dental care at the national level. Methods A nationally representative sample of 12,794 adults aged 20 to 64 years from Korea National Health and Nutritional Examination Survey (2010–2014) was analyzed. To examine the effect of the policy on the outcomes of interest (unmet dental care needs and preventive dental care utilization in the past year), an estimates-based probit model was used, incorporating marginal effects with a complex sampling structure. The effect of the policy on individuals depending on their income and education level was also assessed. Results Adjusting for potential covariates, the probability of having unmet needs for dental care decreased by 6.1% and preventative dental care utilization increased by 14% in the post-policy period compared to those in the pre-policy period (2010, 2012). High income and higher education levels were associated with fewer unmet dental care needs and more preventive dental visits. Conclusions The expansion of coverage to include scaling demonstrated to have a significant association with decreasing unmet dental care needs and increasing preventive dental care utilization. However, the policy disproportionately benefited certain groups, in contrast with the objective of the policy to benefit all participants in the KNHI system.
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Affiliation(s)
- Hee-Jung Park
- Department of Health Policy and Management, Korea University College of Health Sciences, Seoul, Korea
| | - Jun Hyup Lee
- Department of Health Policy and Management, Korea University College of Health Sciences, Seoul, Korea.; BK21 PLUS Program in Embodiment: Health-Society Interaction, Department of Public Health Sciences, Korea University Graduate School, Seoul, Korea
| | - Sujin Park
- Department of Health Policy and Management, Korea University College of Health Sciences, Seoul, Korea
| | - Tae-Il Kim
- Department of Periodontology, Seoul National University School of Dentistry, Seoul, Korea
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Liu Y, Jiang Y, Tang S, Qiu J, Zhong X, Wang Y. Analysis of the equity of emergency medical services: a cross-sectional survey in Chongqing city. Int J Equity Health 2015; 14:150. [PMID: 26689717 PMCID: PMC4687132 DOI: 10.1186/s12939-015-0282-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 12/10/2015] [Indexed: 11/24/2022] Open
Abstract
Background Due to reform of the economic system and the even distribution of available wealth, emergency medical services (EMS) experienced greater risks in equity. This study aimed to assess the equity of EMS needs, utilisation, and distribution of related resources, and to provide evidence for policy-makers to improve such services in Chongqing city, China. Methods Five emergency needs variables (mortality rate of maternal, neonatal, cerebrovascular, cardiovascular, injury and poisoning) from the death surveillance, and two utilisation variables (emergency room visits and rate of utilisation) were collected from Chongqing Health Statistical Year Book 2008 to 2012. We used a concentration index (CI) to assess equality in the distribution of needs and utilisation among three areas with different per-head gross domestic product (GDP). In each area, we randomly chose two districts as sample areas and selected all the medical institutions with emergency services as subjects. We used the Gini coefficient (G) to measure equity in population and geographic distribution of facilities and human resources related EMS. Results Maternal-caused (CI: range −0.213 to −0.096) and neonatal-caused (CI: range −0.161 to −0.046)deaths declined in 2008–12, which focusing mainly on the less developed area. The maternal deaths were less equitably distributed than neonatal, and the gaps between areas gradually become more noticeable. For cerebrovascular (CI: range 0.106 to 0.455), cardiovascular (CI: range 0.101 to 0.329), injury and poisoning (CI: range 0.001 to 0.301) deaths, we documented a steady improvement of mortality; the overall equity of these mortalities was lower than those of maternal and neonatal mortalities, but distinct decreases were seen over time. The patients in developed area were more likely to use EMS (CI: range 0.296 to 0.423) than those in less developed area, and the CI increased over the 5-year period, suggesting that gaps in equity were increasing. The population distribution of facilities, physicians and nurses (G: range 0.2 to 0.3) was relatively equitable; the geographic distribution (G: range 0.4 to 0.5) showed a big gap between areas. Conclusions In Chongqing city, equity of needs, utilization, and resources allocation of EMS is low, and the provision of such services has not met the needs of patients. To narrow the gap of equity, improvement in the capability of EMS to decrease cerebrovascular, cardiovascular, injury and poisoning cases, should be regarded as a top priority. In poor areas, allocation of facilities and human resources needs to be improved, and the economy should also be enhanced.
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Affiliation(s)
- Yalan Liu
- School of Public Health and Management, Chongqing Medical University, the Research Center for Medicine and Social Development, the Innovation Center for Social Risk Governance in Health, Chongqing, China.
| | - Yi Jiang
- School of Public Health and Management, Chongqing Medical University, the Research Center for Medicine and Social Development, the Innovation Center for Social Risk Governance in Health, Chongqing, China.
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Jingfu Qiu
- School of Public Health and Management, Chongqing Medical University, the Research Center for Medicine and Social Development, the Innovation Center for Social Risk Governance in Health, Chongqing, China.
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, the Research Center for Medicine and Social Development, the Innovation Center for Social Risk Governance in Health, Chongqing, China.
| | - Yang Wang
- School of Public Health and Management, Chongqing Medical University, the Research Center for Medicine and Social Development, the Innovation Center for Social Risk Governance in Health, Chongqing, China.
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Does prenatal care benefit maternal health? A study of post-partum maternal care use. Health Policy 2015; 119:1382-9. [DOI: 10.1016/j.healthpol.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 11/21/2022]
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Dwumoh D, Essuman EE, Afagbedzi SK. Determinant of factors associated with child health outcomes and service utilization in Ghana: multiple indicator cluster survey conducted in 2011. ACTA ACUST UNITED AC 2014; 72:42. [PMID: 25810910 PMCID: PMC4373068 DOI: 10.1186/2049-3258-72-42] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 08/27/2014] [Indexed: 11/10/2022]
Abstract
Background The effects of National Health Insurance Scheme in Ghana and its impact on child health outcome and service utilization cannot be underestimated. Despite the tremendous improvement in child health care in Ghana, there are still some challenges in relation to how National health insurance membership, socioeconomic status and other demographic factors impacts on child health outcomes. The study seeks to determine the association between NHIS membership, socio-economic status, geographic location and other relevant background factors, on child health service utilization and outcomes. Methods Secondary data from the Multiple Indicator Cluster Survey conducted in 2011 was used. Multivariate analysis based on Binary Logistic Regression Models and Multiple linear regression techniques was applied to determine factors associated with child health outcomes and service utilization. Collection of best models was based on Hosmer-Lemeshow Goodness-Of-Fit as one criterion of fit and the Akaike Information Criterion. Results Controlling for confounding effect of socioeconomic status, age of the child, mothers education level and geographic location, the odds of a child developing anemia for children with National Health Insurance Scheme Membership is 65.2% [95% CI: 52.9-80.2] times less than children without National Health Insurance Scheme Membership. The odds of being fully immunized against common childhood illnesses for children with NHIS membership is 2.3[95% CI: 1.4-3.7] times higher than children without National Health Insurance Scheme Membership. There was no association between National Health Insurance Scheme Membership and stunted growth in children. Conclusions National Health Insurance Scheme Membership was found to be related to child health service utilization (full immunization) of children under five a child’s anemia status. Children with NHIS are more likely to be fully immunized against common childhood diseases and are less likely to develop anemia. Stunted growth of children was not associated with National Health Insurance Scheme Membership. Health Education on the registration and the use of the National Health Insurance should be made a national priority to enable the Ministry of Health achieve routine Immunization targets and to reduce to the bearers minimum prevalence of anemia.
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Affiliation(s)
- Duah Dwumoh
- Department of Biostatistics, School of Public Health University of Ghana, Legon, Ghana
| | - Edward Eyipe Essuman
- Department of Biological Environmental and Occupational Health Sciences, School of Public Health, University of Ghana, Legon, Ghana
| | - Seth Kwaku Afagbedzi
- Department of Biostatistics, School of Public Health University of Ghana, Legon, Ghana
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Lambon-Quayefio MP, Owoo NS. Examining the influence of antenatal care visits and skilled delivery on neonatal deaths in Ghana. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:511-522. [PMID: 24934923 DOI: 10.1007/s40258-014-0103-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Many Sub-Saharan African countries may not achieve the Millennium Development goal of reducing child mortality by 2015 partly due to the stalled reduction in neonatal deaths, which constitute about 60% of infant deaths. Although many studies have emphasized the importance of accessible maternal healthcare as a means of reducing maternal and child mortality, very few of these studies have explored the affordability and accessibility concerns of maternal healthcare on neonatal mortality. OBJECTIVE This study bridges this research gap as it aims to investigate whether the number of antenatal visits and skilled delivery are associated with the risk of neonatal deaths in Ghana. METHODS Using individual level data of women in their reproductive years from the 2008 Demographic and Health Survey, the study employs an instrumental variable strategy to deal with the potential endogeneity of antenatal care visits. RESULTS Estimates from the instrumental variable estimation show that antenatal care visits reduce the risk of neonatal death by about 2%, while older women have an approximately 0.2% higher risk of losing their neonates than do younger women. CONCLUSION Findings suggest that women who attend antenatal visits have a significantly lower probability of losing their babies in the first month of life. Further, results show that women's age significantly affects the risk of losing their babies in the neonatal stage. However, the study finds no significant effect of skilled delivery and education on neonatal mortality.
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Kao LT, Chen YH, Lin HC, Chung SD. Prescriptions for category D and X drugs during pregnancy in Taiwan: a population-based study. Pharmacoepidemiol Drug Saf 2014; 23:1029-34. [PMID: 24578346 DOI: 10.1002/pds.3599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/22/2014] [Accepted: 01/22/2014] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to investigate the most prescribed medications and principle diagnoses for category D and X drugs during pregnancy using a population-based dataset in Taiwan. METHODS The data for the present study were sourced from the Taiwan Longitudinal Health Insurance Database 2000. We selected 14 125 women who had live singleton births between 1 January 2009 and 31 December 2011. In total, 217 226 prescriptions prescribed to these pregnant women were identified. RESULTS Of the total 217 226 prescriptions, 1.1% were category D or X drugs; in the first, second, and third trimesters of pregnancy, 1.8%, 0.7%, and 0.5% of prescriptions were category D or X drugs, respectively. Progestins (15.3%) and propylthiouracil (10.7%) were the two most frequently prescribed category D or X drugs during pregnancy. In particular, progestins (20.4%) and estrogens (15.6%) were the most frequently prescribed category D or X drug in the first trimester of pregnancy. Propylthiouracil was the most prescribed category D or X drug in the second (20.3%) and third trimesters (23.1%) of pregnancy, respectively. The most common principal diagnosis during pregnancy was "disorders of menstruation and other abnormal bleeding from the female genital tract" (22% of all principal diagnoses for prescribing category D and X drugs). CONCLUSIONS Our study found that the physicians obviously reduced the use of category D and X drugs for women after becoming aware that they were pregnant.
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Affiliation(s)
- Li-Ting Kao
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
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Chen CS, Liu TC, Chen B, Lin CL. The failure of financial incentive? The seemingly inexorable rise of cesarean section. Soc Sci Med 2013; 101:47-51. [PMID: 24560223 DOI: 10.1016/j.socscimed.2013.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 10/13/2013] [Accepted: 11/08/2013] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
| | - Tsai-Ching Liu
- Department of Public Finance, National Taipei University, 151, University Rd., San Shia, New Taipei City 237, Taiwan.
| | - Bradley Chen
- Program in Health Care Financing, Harvard School of Public Health, USA
| | - Chung-Liang Lin
- Department of Economics, National Dong Hwa University, Taiwan
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Owoo NS, Lambon-Quayefio MP. National health insurance, social influence and antenatal care use in Ghana. HEALTH ECONOMICS REVIEW 2013; 3:19. [PMID: 23919511 PMCID: PMC3735509 DOI: 10.1186/2191-1991-3-19] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 07/23/2013] [Indexed: 05/26/2023]
Abstract
The study explores the importance of social influence and the availability of health insurance on maternal care utilization in Ghana through the use of antenatal care services. A number of studies have found that access to health insurance plays a critical role in women's decision to utilize antenatal care services. However, little is known about the role that social forces play in this decision. This study uses village-level data from the 2008 Ghana Demographic and Health Survey to investigate the effects of health insurance and social influences on the intensity of antenatal care utilization by Ghanaian women. Using GIS information at the village level, we employ a spatial lag regression model in this study. Results indicate that, controlling for a host of socioeconomic and geographical factors, women who have health insurance appear to use more antenatal services than women who do not. In addition, the intensity of antenatal visits appears to be spatially correlated among the survey villages, implying that there may be some social influences that affect a woman's decision to utilize antenatal care. A reason for this may be that women who benefit from antenatal care through positive pregnancy outcomes may pass this information along to their peers who also increase their use of these services in response. Traditional/Cultural leaders as "gate-keepers" may be useful in the dissemination of maternal health care information. Public health officials may also explore the possibility of disseminating information relating to maternal care services via the mass media.
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Affiliation(s)
- Nkechi S Owoo
- Department of Economics, University of Ghana, P. O. Box LG 57, Legon, Accra, Ghana
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Chang YH, Chen PY, Li TY, Yeh CN, Li YS, Chu SY, Lee ML. Discrepancy of cytogenetic analysis in Western and eastern Taiwan. Pediatr Neonatol 2013; 54:161-5. [PMID: 23597552 DOI: 10.1016/j.pedneo.2012.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 03/05/2012] [Accepted: 03/15/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE This study aimed at investigating the results of second-trimester amniocyte karyotyping in western and eastern Taiwan, and identifying any regional differences in the prevalence of fetal chromosomal anomalies. METHODS From 2004 to 2009, pregnant women who underwent amniocentesis in their second trimester at three hospitals in western Taiwan and at four hospitals in eastern Taiwan were included. All the cytogenetic analyses of cultured amniocytes were performed in the cytogenetics laboratory of the Genetic Counseling Center of Hualien Buddhist Tzu Chi General Hospital. We used the chi-square test, Student t test, and Mann-Whitney U test to evaluate the variants of clinical indications, amniocyte karyotyping results, and prevalence and types of chromosomal anomalies in western and eastern Taiwan. RESULTS During the study period, 3573 samples, 1990 (55.7%) from western Taiwan and 1583 (44.3%) from eastern Taiwan, were collected and analyzed. The main indication for amniocyte karyotyping was advanced maternal age (69.0% in western Taiwan, 67.1% in eastern Taiwan). The detection rates of chromosomal anomalies by amniocyte karyotyping in eastern Taiwan (45/1582, 2.8%) did not differ significantly from that in western Taiwan (42/1989, 2.1%) (p = 1.58). Mothers who had abnormal ultrasound findings and histories of familial hereditary diseases or chromosomal anomalies had higher detection rates of chromosomal anomalies (9.3% and 7.2%, respectively). The detection rate of autosomal anomalies was higher in eastern Taiwan (93.3% vs. 78.6%, p = 0.046), but the detection rate of sex-linked chromosomal anomalies was higher in western Taiwan (21.4% vs. 6.7%, p = 0.046). CONCLUSION We demonstrated regional differences in second-trimester amniocyte karyotyping results and established a database of common chromosomal anomalies that could be useful for genetic counseling, especially in eastern Taiwan.
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Affiliation(s)
- Yu-Hsun Chang
- Department of Pediatrics, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; Institute of Medical Science, Tzu Chi University, Hualien, Taiwan
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Hsiao YY, Cheng SH. Is there a disparity in the hospital care received under a universal health insurance program in Taiwan? Int J Qual Health Care 2013; 25:232-8. [PMID: 23548442 DOI: 10.1093/intqhc/mzt029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yu-Yu Hsiao
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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Wang SI, Yaung CL. Vertical equity of healthcare in Taiwan: health services were distributed according to need. Int J Equity Health 2013; 12:12. [PMID: 23363855 PMCID: PMC3570366 DOI: 10.1186/1475-9276-12-12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 01/24/2013] [Indexed: 11/16/2022] Open
Abstract
Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. Conclusions The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan’s experience can serve as a reference for health reform.
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Affiliation(s)
- Shiow-Ing Wang
- National Environmental Health Research Center, National Health Research Institutes, Miaoli County, Taiwan.
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Abstract
OBJECTIVES To ensure people's fundamental right to adequate medical care, universal health insurance is given a high priority in contemporary public policy. This article investigates the effects of the introduction of Taiwan's National Health Insurance (NHI) on life satisfaction within the elderly segment of the population. METHODS A longitudinal data set including 610 males and 430 females aged 65 or above was constructed from the Survey of Health and Living Status of the Elderly in Taiwan. A difference-in-differences-in-differences model was employed and estimated by the random-effect regression method. RESULTS The effects of NHI on life satisfaction are different by gender. Compared to the change in life satisfaction between the previously uninsured and insured elderly men, the introduction of NHI had a larger effect of 4.330 points on reducing the disparity in life satisfaction between previously uninsured and insured elderly women. Education, living arrangements, lifestyle, social activities, geographic location, and urbanization level are also important determinants for life satisfaction among the elderly. CONCLUSIONS Although NHI is designed to ensure equality for accessing health care, the implementation of NHI has also improved the subjective well-being of the elderly, with a larger improvement for the elderly women. The post-NHI disparity reductions in life satisfaction between the previously uninsured and insured are significantly greater among elderly women. Our analysis of Taiwan's experience should provide a valuable lesson to countries that are in the initial stages of proposing a universal health insurance program.
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Affiliation(s)
- Pei-An Liao
- Department of Economics, Shih Hsin University, Taipei, Taiwan
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Liao PA, Chang HH, Yang FA. Does the universal health insurance program affect urban-rural differences in health service utilization among the elderly? Evidence from a longitudinal study in taiwan. J Rural Health 2011; 28:84-91. [PMID: 22236318 DOI: 10.1111/j.1748-0361.2011.00363.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. METHODS A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences model was employed and estimated by the random-effect probit method. FINDING The introduction of universal NHI in Taiwan heterogeneously affected outpatient and inpatient health service utilization among the elderly in urban and rural areas. The introduction of NHI reduced the disparity of outpatient (inpatient) utilization between the previously uninsured and insured older urban residents by 12.9 (22.0) percentage points. However, there was no significant reduction in the utilization disparity between the previously uninsured and insured elderly among rural residents. CONCLUSIONS Our study on Taiwan's experience should provide a valuable lesson to countries that are in an initial stage of proposing a universal health insurance system. Although NHI is designed to ensure the equitable right to access health care, it may result in differential impacts on health service utilization among the elderly across areas. The rural elderly tend to confront more challenges in accessing health care associated with spatial distance, transportation, social isolation, poverty, and a lack of health care providers, especially medical specialists.
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Affiliation(s)
- Pei-An Liao
- Department of Economics, Shih Hsin University, Taipei, Taiwan Department of Agricultural Economics, National Taiwan University, Taipei, Taiwan
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Hsu TH, Su HY, Liao PP. Enhancing value creation of device vendors in the medical service industry: a relationship perspective. SERVICE INDUSTRIES JOURNAL 2010. [DOI: 10.1080/02642060802624316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tian WH, Chen CS, Liu TC. The demand for preventive care services and its relationship with inpatient services. Health Policy 2009; 94:164-74. [PMID: 19853320 DOI: 10.1016/j.healthpol.2009.09.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Revised: 09/10/2009] [Accepted: 09/21/2009] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Wei-Hua Tian
- Department of Economics, National Cheng Kung University, Taiwan
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21
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Prenatal examination utilization and its determinants for immigrant women in Taiwan: an exploratory study. J Nurs Res 2009; 17:73-82. [PMID: 19352231 DOI: 10.1097/jnr.0b013e3181999ee8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to understand and explore determinants of prenatal examination utilization by pregnant immigrant women in Taiwan. This cross-sectional study surveyed 101 pregnant Vietnamese women living in northern Taiwan. Data collection employed face-to-face interviews using a structured questionnaire. Main findings included that participants were relatively young (M +/- SD = 23.3 +/- 3.15 years old) and that length of residency in Taiwan averaged just over 1 year (M +/- SD = 13.3 +/- 9.48 months). Results also indicated the prenatal examination rate for this target group to be relatively high. First prenatal examinations were conducted, on average, 10.8 weeks into pregnancy (SD = 4.37 weeks). Most participants (83.2%) received prenatal examinations in accordance with the recommended schedule. Regional hospitals (35.6%) and local obstetrics clinics (35.6%) were the most frequently chosen locations for prenatal examinations followed by medical centers (15.8%) and district hospitals (12.9%). Participant spouses and/or mother-in-laws heavily influenced the decision regarding where to conduct prenatal examinations. The average general language ability score was 9.5 (SD = 2.05, range = 4-16), indicating a low to moderate average language ability. However, only 9.9% (n = 10) of participants utilized translation services offered by the hospital. In terms of factors influencing utilization of the prenatal examination service, this study identified significantly positive relationships between utilization and the variables life adaptation and perceived importance of the examination. In contrast, results showed loneliness to be negatively related to prenatal examination utilization. On the basis of these results, we suggest that more accessible information on the prenatal examination service needs to be provided to improve adaptation by immigrant women to life in Taiwan and that psychiatric support be offered to help reduce the feelings of depression felt by these women. The importance of prenatal examination to enable women to acquire more appropriate and comprehensive prenatal care and to improve prenatal care quality should be emphasized.
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Quimbo S, Florentino J, Peabody JW, Shimkhada R, Panelo C, Solon O. Underutilization of social insurance among the poor: evidence from the Philippines. PLoS One 2008; 3:e3379. [PMID: 18852881 PMCID: PMC2557126 DOI: 10.1371/journal.pone.0003379] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 09/15/2008] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many developing countries promote social health insurance as a means to eliminate unmet health needs. However, this strategy may be ineffective if there are barriers to fully utilizing insurance. METHODS We analyzed the utilization of social health insurance in 30 hospital districts in the central regions of the Philippines between 2003 and 2007. Data for the study came from the Quality Improvement Demonstration Study (QIDS) and included detailed patient information from exit interviews of children under 5 years of age conducted in seven waves among public hospital districts located in the four central regions of the Philippines. These data were used to estimate and identify predictors of underutilization of insurance benefits--defined as the likelihood of not filing claims despite having legitimate insurance coverage--using logistic regression. RESULTS Multivariate analyses using QIDS data from 2004 to 2007 reveal that underutilization averaged about 15% throughout the study period. Underutilization, however, declined over time. Among insured hospitalized children, increasing length of stay in the hospital and mother's education, were associated with less underutilization. Being in a QIDS intervention site was also associated with less underutilization and partially accounts for the downward trend in underutilization over time. DISCUSSION The surprisingly high level of insurance underutilization by insured patients in the QIDS sites undermines the potentially positive impact of social health insurance on the health of the marginalized. In the Philippines, where the largest burden of health care spending falls on households, underutilization suggests ineffective distribution of public funds, failing to reach a significant proportion of households which are by and large poor. Interventions that improve benefit awareness may combat the problem of underutilization and should be the focus of further research in this area.
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Affiliation(s)
- Stella Quimbo
- School of Economics, University of the Philippines, Diliman, Quezon City, Philippines
| | - Jhiedon Florentino
- School of Economics, University of the Philippines, Diliman, Quezon City, Philippines
| | - John W. Peabody
- Institute for Global Health, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Riti Shimkhada
- Institute for Global Health, University of California San Francisco, San Francisco, California, United States of America
| | - Carlo Panelo
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Orville Solon
- School of Economics, University of the Philippines, Diliman, Quezon City, Philippines
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Sepehri A, Sarma S, Simpson W, Moshiri S. How important are individual, household and commune characteristics in explaining utilization of maternal health services in Vietnam? Soc Sci Med 2008; 67:1009-17. [PMID: 18635302 DOI: 10.1016/j.socscimed.2008.06.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Indexed: 10/21/2022]
Abstract
Using Vietnam's latest National Household Survey data for 2001-2002 this paper assesses the influence of individual, household and commune-level characteristics on a woman's decision to seek prenatal care, on the number of prenatal visits, and on the choice between giving birth at a health facility or at home. The decision to use any care and the number of prenatal visits is modeled using a two-part model. A random intercept logistic model is used to capture the influence of unobserved commune-specific factors found in the data regarding a woman's decision to give birth at a health facility rather than at home. The results show that access to prenatal care and delivery assistance is limited by observed barriers such as low income, low education, ethnicity, geographical isolation and a high poverty rate in the community. More specifically, more prenatal visits increase the likelihood of giving birth at a health facility. Having compulsory health insurance increases the odds of giving birth at a health facility for middle and high income women. In contrast, health insurance for the poor increases the likelihood of having more prenatal visits but has little effect on the place of delivery. These results suggest that the existing safe motherhood programs should be linked with the objectives of social development programs such as poverty reduction, and that policy makers need to view both the individual and the commune as appropriate units for policy targeting.
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Affiliation(s)
- Ardeshir Sepehri
- Department of Economics, University of Manitoba, Winnipeg, Manitoba, Canada.
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Chen L, Chen CL, Yang WC. The influences of Taiwan's National Health Insurance on women's choice of prenatal care facility: Investigation of differences between rural and non-rural areas. BMC Health Serv Res 2008; 8:67. [PMID: 18373869 PMCID: PMC2387151 DOI: 10.1186/1472-6963-8-67] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2007] [Accepted: 03/29/2008] [Indexed: 12/04/2022] Open
Abstract
Background Taiwan's National Health Insurance (NHI), implemented in 1995, substantially increased the number of health care facilities that can deliver free prenatal care. Because of the increase in such facilities, it is usually assumed that women would have more choices regarding prenatal care facilities and thus experience reduction in travel cost. Nevertheless, there has been no research exploring these issues in the literature. This study compares how Taiwan's NHI program may have influenced choice of prenatal care facility and perception regarding convenience in transportation for obtaining such care for women in rural and non-rural areas in Taiwan. Methods Based on data collected by a national survey conducted by Taiwan's National Health Research Institutes (NHRI) in 2000, we tried to compare how women chose prenatal care facility before and after Taiwan's National Health Insurance program was implemented. Basing our analysis on how women answered questionnaire items regarding "the type of major health care facility used and convenience of transportation to and from prenatal care facility," we investigated whether there were disparities in how women in rural and non-rural areas chose prenatal care facilities and felt about the transportation, and whether the NHI had different influences for the two groups of women. Results After NHI, women in rural areas were more likely than before to choose large hospitals for prenatal care services. For women in rural areas, the relative probability of choosing large hospitals to choosing non-hospital settings in 1998–1999 was about 6.54 times of that in 1990–1992. In contrast, no such change was found in women in non-rural areas. For a woman in a non-rural area, she was significantly more likely to perceive the transportation to and from prenatal care facilities to be very convenient between 1998 and 1999 than in the period between 1990 and 1992. No such improvement was found for women in rural areas. Conclusion We concluded that women in rural areas were more likely to seek prenatal care in large hospitals, but were not more likely to perceive very convenient transportation to and from prenatal care facilities in the late 1990s than in the early 1990s. In contrast, women in non-rural areas did not have a stronger tendency to seek prenatal care in large hospitals in the late 1990s than in earlier periods. In addition, they did perceive an improvement in transportation for acquiring prenatal care in the late 1990s. More efforts should be made to reduce these disparities.
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Affiliation(s)
- Likwang Chen
- Centre for Health Policy Research and Development, National Health Research Institutes, No,35 Keyan Road, Zhunan Town, Miaoli County 350, Taiwan.
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Chen CS, Liu TC, Lin HC, Tian WH. The effect of Taiwan's National Health Insurance on infants’ preventive care use and inpatient care use. Health Policy 2007; 80:432-43. [PMID: 16750587 DOI: 10.1016/j.healthpol.2006.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 04/19/2006] [Accepted: 04/24/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To test whether utilization of infant preventive care services has reduced utilization of inpatient care and to determine whether implementation of Taiwan's National Health Insurance (NHI) has brought about any differences in the utilization of infant health care services. DATA SOURCES Data were taken from the 1989 and 1996 National Maternal and Infant Health Surveys (NMIHSs). In total, 1662 and 3623 effective samples were used in the study from the 2 years. STUDY DESIGN We constructed a simultaneous recursive model to obtain efficient estimates by treating preventive care (neonatal care and well-baby care) and inpatient care (hospitalization admissions) as dependent variables. PRINCIPAL FINDINGS Utilization of neonatal care had strongly negative significant coefficients for the likelihood of being admitted to the hospital. The impact of the NHI was found to be significant. CONCLUSIONS The hypothesis that the NHI interferes with the effectiveness of preventive care at reducing inpatient care use was not reinforced. Since support from the NHI depends on a balance of push and pull between access to inpatient care and the benefits of preventive care, it can further improve infant health by promoting the benefits of preventive care while making both types of care more accessible.
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Affiliation(s)
- Chin-Shyan Chen
- Department of Economics National Taipei University, Taipei, Taiwan
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26
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Chu TB, Liu TC, Chen CS, Tsai YW, Chiu WT. Household out-of-pocket medical expenditures and National Health Insurance in Taiwan: income and regional inequality. BMC Health Serv Res 2005; 5:60. [PMID: 16137336 PMCID: PMC1208885 DOI: 10.1186/1472-6963-5-60] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Accepted: 09/02/2005] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Tu-Bin Chu
- Taipei Municipal Wan Fang Hospital, Taipei, Taiwan
| | - Tsai-Ching Liu
- Taipei Municipal Wan Fang Hospital, Taipei, Taiwan
- Department of Public Finance, National Taipei University, Taipei, Taiwan
| | - Chin-Shyan Chen
- Taipei Municipal Wan Fang Hospital, Taipei, Taiwan
- Department of Economics, National Taipei University, Taipei, Taiwan
| | - Yi-Wen Tsai
- Division of Health Plicy Research, National Health Research Institues, Taipei, Taiwan
| | - Wen-Ta Chiu
- Taipei Municipal Wan Fang Hospital, Taipei, Taiwan
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Chen CS, Liu TC. The Taiwan National Health Insurance program and full infant immunization coverage. Am J Public Health 2005; 95:305-11. [PMID: 15671469 PMCID: PMC1449171 DOI: 10.2105/ajph.2002.012567] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared hospital-born infants and well-baby care use associated with complete immunizations in Taiwan before and after institution of National Health Insurance (NHI). METHODS We used logistic regression to analyze data from 1989 and 1996 National Maternal and Infant Health Surveys of 1398 and 3185 1-year-old infants, respectively. RESULTS Infants born in hospitals were found to receive fewer immunizations than those born elsewhere before NHI but significantly more after NHI. Use of well-baby care correlates strongly and positively with the probability that a child will receive a full course of immunization after NHI. CONCLUSIONS The NHI policy of including hospitals as immunization providers facilitates access to immunization services for children born in those facilities. Through NHI provision of free well-baby care, health planners have stimulated the demand for immunization.
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Affiliation(s)
- Chin-Shyan Chen
- Department of Public Finance, National Taipei University, 67, Sec. 3, Ming-Shen E. Road, Taipei 104, Taiwan
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Anson O. Utilization of maternal care in rural HeBei Province, the People's Republic of China: individual and structural characteristics. Health Policy 2004; 70:197-206. [PMID: 15364149 DOI: 10.1016/j.healthpol.2004.03.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE To study the effect of individual's socio-economic characteristics and the structure of the health services in the village on utilization of maternal care in rural HeBei, the People's Republic of China (PRC). DATA Data were collected from 4273 women who gave birth to one child at least, living in a stratified sample of 288 villages in HeBei Province. FINDINGS 54.8% of the women had at least one pre-natal care visit, 27.5% gave birth in a health care facility, and 18.1% had post-natal check-up. Utilization was inversely related to age and parity and positively to education. Occupation was related to use of pre- and post-natal services, but not to home birth. Per-capita income and living arrangement are not related to utilization. MCH worker in the village promote pre- and post-natal care, but also home delivery. Village doctors promote pre-natal care and hospital delivery but do not promote post-natal check-up. Women tend to avoid the maternal services in the township health centers but some are ready to travel to city hospitals for delivery and post-natal care. CONCLUSIONS Health education programs regarding the importance of all three maternal care services are clearly needed. These programs should address not only women of child bearing age but also care providers, MCH workers in particular. Township health center should reach-out and motivate women to use their accessible services.
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Affiliation(s)
- Ofra Anson
- Faculty of Health Sciences, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel.
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