Health Services Utilization and its Relative Factors before and after receiving Assistance Schemes for those Insured who Owed Premium – Using Taipei Branch of Bureau of National Health Insurance as an Example

Background and objectives: The goal of the National health insurance (NHI) is to gather the strength of the whole society, so to help reduce the economic barrier when seeking medical services. The ultimate goal of NHI is to take care of the health of the public. However, along with the economic depression, many people could face difficulties derived from long-term unemployment or unexpected family crisis. They may not be able to pay the insurance premium on time, and temporarily can not use their insured status when seeking medical care. This research aims to explore the differences in the healthcare utilization one year before and after the disadvantaged insured apply for the assistance schemes and to compare their medical usage with the ordinary person, as well as to discuss relative factors.ethod: Currently, the relief funds loan and installment are the major assistance schemes available to help those who are facing difficulty in paying the premium on time. The study subjects of this research were the insured and their family dependants applying for the relief funds loan and the installment in the Taipei branch of NHI Bureau in 2007. Totally 1,116 persons were included in the relief funds loan group, and 93,198 persons in the installment group. The data of their healthcare utilization one year before and after applying for assistance schemes were collected. The subjects in the control group were sampled from the insured population in the same branch stratified by genders and age groups. Totally 93,336 persons were selected in the control group, whose medical expenditure data were retrieved and compared with that of the experimental groups by detailed analyses as follows. In finding out the differences in healthcare utilization and the relative factors during one year before and after receiving assistance schemes for those insured who owed premium, there are several indicators to be adopted and observed. The “difference in difference” analysis was used to compare the healthcare utilization of persons with loan or installment and the control group. Three indices of healthcare utilization, “total medical expenditure”, “outpatient service medical expenditure” and “hospitalization expenditure”, were the dependant variables for the linear multivariate regression model.esults: 1.It is found that total medical treatment and outpatient services, number of outpatient clinic visits, relative value units of outpatient clinics, number of emergency visits, and hospitalization all increased after the disadvantaged insured received the assistance. It’s also found that the differences of healthcare utilization between the experimental group and the control group reduced significantly. Especially, number of the emergency visits and hospitalization rate were even higher in the experimental group. 2. Multivariate regression analyses revealed that total medical expenditure and outpatient expenditure increased significantly for experiment group. Specifically, those who in installment had more increment of their total medical expenditure, but such increase was more obvious in the clinical expenditure of those who applying relief funds loan. Hospitalization expenditure increased for installment applicants, but the insured with relief funds loan had increased hospitalization expenditure without consistent changing pattern. 3. The peak of utilization of hospitalization and emergency visits appeared at one month before applying the relief loan and installment. The second peak appeared at the first month of the schemes. The peak utilization of outpatient was at the first month after the relief loan and installment. 4. The medical expenditures were affected by predisposing factors, availability factors and demand factors. Significant differences were observed in total medical expenditure, outpatient expenditure and hospitalization expenditure with respect to age, gender, race, the degree of physical and psychological disabilities, the types of chronic illness, or severe illness. Different categories of the insured had significantly different expenditure of total medical services and hospitalization; while geographical differences greatly influenced the outpatient clinic visits.onclusion: Generally speaking, the relief funds loan and the installment surely can reduce the economic barriers when seeking medical treatment for the insured who can not pay premium on time . Moreover, lenient repayment terms on the relief loan could provide even greater help than the installment program in the utilization rate and number of medical services. Indeed, those who applied for the loans and the installments were the ones desperately needing the services due to severe illness. These two schemes practically assisted the owed-premium insured with healthcare of emergent and severe illness in time.ecommendations: 1. The competent authority should continuously implement owed-premium assistance schemes for economically disadvantaged population. 2. The problems of owed premiums for aborigines require special attention and could be solved partially by feasible premium assistance schemes.