The influence on the medical utilization and the improvement of accessibility of the implementation of Integrated Delivery System in rural-mountain areas--A case study of Mwudan Siang, a mountain aboriginal village in southern Taiwan
Date Issued
2004
Date
2004
Author(s)
Yang, Kuei-Lan
DOI
zh-TW
Abstract
In order to improve accessibility of medical and health services at remote mountain areas, the Bureau of National Health Insurance (NHI) has implemented Integrated Delivery Systems (IDS) in all the mountain village since 1999. The purposes of the research were to evaluate the effectiveness of the IDS implemented in Mwudan Siang, during the period of July, 2001 to June, 2003. We wanted to see the first, whether the policy has influences on the residents’ medical-seeking behaviors and what are the major parts of it；and the 2nd ,what and which characters of these residents might influence on their medical-seeking decision ,preference in or outside the village.
This study used the insurance database provided by the Bureau of NHI. A total of 5,015 residents of Mwudan Siang were included in the study. The study results show: 1). The rate of out-patient utilization inside the village increased significantly from 20.3% to 28.4% after the IDS was implemented (p<0.0001); 2). The average medical cost of outpatient inside the village decreased significantly from NT$ 648.1 to NT$611.0 after IDS (p<0.0001), 3).Rates of visit due to acute upper respiratory, arthritis, skin disease, low back pain, eyes disease, gastroenteritis, gout, and Diabetes mellitus were all significantly increased inside the village after IDS (p<0.001); 4).Admission rate increased significantly (p<0.0001) but avoidable hospitalization conditions decreased significantly after IDS (p<0.001 ); 5). Utilization rate of adult preventive health service and cervical cancer screening increased significantly inside the village after IDS (p<0.001); 6).The factors affecting out-patient utilization were analyzed with multiple logistic regression. The results revealed the following significant factors : predisposing factors (female, age>65, married), enabling factors (living in Si-menh village, the category III insurance), and need factors (chronic disease patients); 7.) The factors affecting inside the village out-patient utilization were analyzed with multiple regression model, the results show that some factors favored inside-village out-patient utilization: predisposing factors (female, age>65, elementary school education, the singles), enabling factors: (living in Si-menh and Kau-sih villages, the category III insurance) and need factors: (chronic disease patients).
In general, the IDS program successfully increased the accessibility of medical care of the villagers. According to the study results, we suggest the authority should establish the system to manage chronic disease, and reinforce the service and education in disease prevention to improve the quality of medical care and health status in the aboriginal mountain area.
Subjects
全民健康保險山地離島醫療給付效益提昇計畫
可近性
原住民
醫療利用
Integrated Delivery System
Accessibility
Aboriginal
medical utilization
SDGs
Type
thesis
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