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International Journal of Health Economics and Management

Published in:

01-12-2013

Awareness and utilization of preventive care services among the elderly under National Health Insurance

Authors: Chun-Chih Chen, Yen-Ju Lin, Ying-Tzu Lin

Published in: International Journal of Health Economics and Management | Issue 3-4/2013

Abstract

This empirical study investigates the factors affecting the awareness and the utilization of preventive care among the elderly in Taiwan. We use data obtained from the 2005 National Health Interview Survey. A recursive bivariate probit model is adopted to analyze the factors affecting the awareness and the utilization of preventive care. The probability of awareness of free preventive care under the National Health Insurance is higher for those who are younger, Mainlanders, have received more education, have a spouse, exercise regularly, have better self-rated health status, and have chronic diseases; the probability of awareness is lower for those who are aborigines and who live in the south and the east. Awareness of preventive care services, having a spouse, living alone, having better health status, and the existence of chronic diseases increase the probability of preventive care utilization; working reduces the probability of preventive care utilization. Our result supports the views in Arrow (Am Econ Rev 53(5):941–973, 1963) that health information is an important factor determining the demand for medical care. Policymakers may enhance such preventive care service utilization by increasing the awareness of such services among the elderly.

We also estimate the model by removing “education years” from exclusion restriction list and thus the covariates of both equations contain “education years”. The estimation result shows that “education years” is significant in Awareness equation (Eq. 1) but insignificant in Preventive equation (Eq. 2). The result may suggest that education influence preventive care utilization mainly through “Awareness” in our application.

Some readers may have concern for the marginal result. The value (p = 0.098) is obtained from Stata command “biprobit”. We also performed the test using the procedure “mvprobit” (Version 3) provided by Cappellari and Jenkins (2003). The p value of the LR test from “mvprobit” is 0.078. Therefore, we think it is adequate to apply bivariate probit model in our analysis.

We also transform the variables of Income and Self-rated health from ordinal variables to a set of dummies and re-estimate the model. Coefficients estimated have changed slightly and the main findings remain unchanged. For Eq. 1, Age, Spouse, Education years, Mainlander, Other, Exercise, Southern area, Eastern area, and Chronic diseases are still significant. Self-rated health becomes two dummies (fair and good) and both significantly increase the likelihood of Awareness (Poor health is used as the reference group). For Eq. 2, Awareness, Age, Spouse, Living alone, Employment, and Chronic diseases remain significant. Fair health and good health marginally increase the likelihood of utilization with p values of 0.103 and 0.090, respectively.

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Title: Awareness and utilization of preventive care services among the elderly under National Health Insurance
Authors: Chun-Chih Chen
Yen-Ju Lin
Ying-Tzu Lin
Publication date: 01-12-2013
Publisher: Springer US
Published in: International Journal of Health Economics and Management / Issue 3-4/2013
Print ISSN: 2199-9023
Electronic ISSN: 2199-9031
DOI: https://doi.org/10.1007/s10754-013-9128-3

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Awareness and utilization of preventive care services among the elderly under National Health Insurance

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