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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2013

Open Access 01-12-2013 | Research

Vertical equity of healthcare in Taiwan: health services were distributed according to need

Authors: Shiow-Ing Wang, Chih-Liang Yaung

Published in: International Journal for Equity in Health | Issue 1/2013

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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.
Appendix
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Literature
1.
Culyer TJ, Wagstaff A: Centre for Health Economics. Need, equality and social justice. 1991, University of York: Working Papers
2.
Organisation for Economic Co-Operation and Development: Towards High-Performing Health Systems. 2004, Paris: Organisation for Economic Co-Operation and Development(OECD)
3.
Institute of Medicine: Care without coverage: too little, too late. 2002
4.
World Health Organization: Preventing chronic diseases: a vital investment. 2005, Geneva: World Health Organization
5.
6.
Ahmed H: Effects of poverty on child health and paediatric practice in Nigeria: an overview. Ann Afr Med. 2007, 6 (4): 142-156. 10.4103/1596-3519.55705.CrossRefPubMed
7.
Yeh H-J, Chen C-S, Liu T-C: The Research Committee on Social Stratification. Equity in the Delivery of Health Care in Taiwan. 2003, Tokyo: The International Sociological Association
8.
Piette JD, Moos RH: The influence of distance on ambulatory care use, death, and readmission following a myocardial infarction. Health Serv Res. 1996, 31 (5): 573-591.PubMedCentralPubMed
9.
Buchanan AE: The right to a decent minimum of health care. Philos Public Aff. 1984, 13 (1): 55-78.PubMed
10.
Huang N, Yip W, Chang HJ, Chou YJ: Trends in rural and urban differentials in incidence rates for ruptured appendicitis under the National Health Insurance in Taiwan. Public Health. 2006, 120 (11): 1055-1063. 10.1016/j.puhe.2006.06.011.CrossRefPubMed
11.
Chen CS, Liu TC, Chen LM: National Health Insurance and the antenatal care use: a case in Taiwan. Health Policy. 2003, 64 (1): 99-112. 10.1016/S0168-8510(02)00141-0.CrossRefPubMed
12.
Sachs J: Macroeconomics and health: investing in health for economic development. 2001, Geneva: World Health Organization
13.
Mooney G: And now for vertical equity? Some concerns arising from aboriginal health in Australia. Health Econ. 1996, 5 (2): 99-103. 10.1002/(SICI)1099-1050(199603)5:2<99::AID-HEC193>3.0.CO;2-N.CrossRefPubMed
14.
Mooney G: Vertical equity in health care resource allocation. Health Care Anal. 2000, 8 (3): 203-215. 10.1023/A:1009439917796.CrossRefPubMed
15.
Mooney G, Jan S: Vertical equity: weighting outcomes? or establishing procedures?. Health Policy. 1997, 39 (1): 79-87. 10.1016/S0168-8510(96)00851-2.CrossRefPubMed
16.
Organisation for Economic Cooperation and Development: Health at a Glance: OECD Indicators 2003. 2003, Organisation for Economic Co-Operation and Development(OECD), ISSN:1995-3992
17.
18.
Dubikaytis T, Larivaara M, Kuznetsova O, Hemminki E: Inequalities in health and health service utilisation among reproductive age women in St. Petersburg, Russia: a cross-sectional study. BMC Health Serv Res. 2010, 10: 307-10.1186/1472-6963-10-307.PubMedCentralCrossRefPubMed
19.
Clegg LX, Reichman ME, Miller BA, Hankey BF, Singh GK, Lin YD, Goodman MT, Lynch CF, Schwartz SM, Chen VW: Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality Study. Cancer Causes Control. 2009, 20 (4): 417-435. 10.1007/s10552-008-9256-0.CrossRefPubMed
20.
Lu JF, Leung GM, Kwon S, Tin KY, Van Doorslaer E, O’Donnell O: Horizontal equity in health care utilization evidence from three high-income Asian economies. Soc Sci Med. 2007, 64 (1): 199-212. 10.1016/j.socscimed.2006.08.033.CrossRefPubMed
21.
van Doorslaer E, Koolman X, Jones AM: Explaining income-related inequalities in doctor utilisation in Europe. Health Econ. 2004, 13 (7): 629-647. 10.1002/hec.919.CrossRefPubMed
22.
van Doorslaer E, Koolman X, Puffer F: Measuring up: Improving health systems performance in OECD countries. Equity in the use of physician visits in OECD countries: Has equal treatment for equal need been achieved?. 2002, Paris: OECD
23.
24.
25.
Shih YT, Hung YT, Chang HY, Liu JP, Lin HS, Chang MC, Chang FC, Hsiung CA, Wu SL: The design, contents, operation and the characteristics of the respondents of the 2001 National Health Interview Survey in Taiwan. Taiwan J Public Health. 2003, 22: 419-430. in Chinese
26.
Donabedian A: Aspects of Medical Care Administration: Specifying Requirements for Health Care. 1973, Cambridge: Harvard University Press
27.
Kaplan GA, Goldberg DE, Everson SA, Cohen RD, Salonen R, Tuomilehto J, Salonen J: Perceived health status and morbidity and mortality: evidence from the Kuopio ischaemic heart disease risk factor study. Int J Epidemiol. 1996, 25 (2): 259-265. 10.1093/ije/25.2.259.CrossRefPubMed
28.
29.
DeSalvo KB, Fan VS, McDonell MB, Fihn SD: Predicting mortality and healthcare utilization with a single question. Health Serv Res. 2005, 40 (4): 1234-1246. 10.1111/j.1475-6773.2005.00404.x.PubMedCentralCrossRefPubMed
30.
Miilunpalo S, Vuori I, Oja P, Pasanen M, Urponen H: Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population. J Clin Epidemiol. 1997, 50 (5): 517-528. 10.1016/S0895-4356(97)00045-0.CrossRefPubMed
31.
Wannamethee G, Shaper AG: Self-assessment of health status and mortality in middle-aged British men. Int J Epidemiol. 1991, 20 (1): 239-245. 10.1093/ije/20.1.239.CrossRefPubMed
32.
Rogers RG, Hummer RA, Nam C: Living and Dying in the USA. Perceived Health Status and Mortality. 2000, San Diego: Academic Press, 175-195.
33.
Thong MS, Kaptein AA, Benyamini Y, Krediet RT, Boeschoten EW, Dekker FW: Association between a self-rated health question and mortality in young and old dialysis patients: a cohort study. Am J Kidney Dis. 2008, 52 (1): 111-117. 10.1053/j.ajkd.2008.04.001.CrossRefPubMed
34.
Idler EL, Benyamini Y: Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav. 1997, 38 (1): 21-37. 10.2307/2955359.CrossRefPubMed
35.
Wolinsky FD, Johnson RJ: Perceived health status and mortality among older men and women. J Gerontol. 1992, 47 (6): S304-312. 10.1093/geronj/47.6.S304.CrossRefPubMed
36.
Martin LM, Leff M, Calonge N, Garrett C, Nelson DE: Validation of self-reported chronic conditions and health services in a managed care population. Am J Prev Med. 2000, 18 (3): 215-218. 10.1016/S0749-3797(99)00158-0.CrossRefPubMed
37.
Daniels N: Health-care needs and distributive justice. Philos Public Aff. 1981, 10 (2): 146-179.PubMed
38.
Adedigba MA, Ogunbodede E, Jeboda SO, Naidoo S: Self-perceived and unmet general health need among PLWHA in Nigeria. East Afr J Public Health. 2008, 5 (3): 199-204.PubMed
39.
Szwarcwald CL, Souza-Junior PR, Damacena GN: Socioeconomic inequalities in the use of outpatient services in Brazil according to health care need: evidence from the World Health Survey. BMC Health Serv Res. 2010, 10: 217-10.1186/1472-6963-10-217.PubMedCentralCrossRefPubMed
40.
Quesnel-Vallee A: Self-rated health: caught in the crossfire of the quest for ‘true’ health?. Int J Epidemiol. 2007, 36 (6): 1161-1164. 10.1093/ije/dym236.CrossRefPubMed
41.
Wagstaff A, Paci P, van Doorslaer E: On the measurement of inequalities in health. Soc Sci Med. 1991, 33 (5): 545-557. 10.1016/0277-9536(91)90212-U.CrossRefPubMed
42.
Fuller MF, Lury DA: Statistics Workbook for Social Science Students. 1977, Oxford, United Kingdom: Phillip Allan
43.
44.
Castro-Leal F, Dayton J, Demery L, Mehra K: Public spending on health care in Africa: do the poor benefit?. Bull World Health Organ. 2000, 78 (1): 66-74.PubMedCentralPubMed
45.
Glazier RH, Agha MM, Moineddin R, Sibley LM: Universal health insurance and equity in primary care and specialist office visits: a population-based study. Ann Fam Med. 2009, 7 (5): 396-405. 10.1370/afm.994.PubMedCentralCrossRefPubMed
46.
Keleher H: Why primary health care offers a more comprehensive approach for tackling health inequities than primary care. Aust J Prim Health. 2001, 7 (2): 57-61. 10.1071/PY01035.CrossRef
47.
Franks P, Nutting PA, Clancy CM: Health care reform, primary care, and the need for research. JAMA. 1993, 270 (12): 1449-1453. 10.1001/jama.1993.03510120071033.CrossRefPubMed
48.
Shi L, Starfield B, Politzer R, Regan J: Primary care, self-rated health, and reductions in social disparities in health. Health Serv Res. 2002, 37 (3): 529-550. 10.1111/1475-6773.t01-1-00036.PubMedCentralCrossRefPubMed
49.
Rajmil L, Starfield B, Plasencia A, Segura A: The consequences of universalizing health services: children’s use of health services in Catalonia. Int J Health Serv. 1998, 28 (4): 777-791. 10.2190/MY1V-972V-U7CA-VE6P.CrossRefPubMed
50.
51.
Lalonde M: A New Perspective on the Health of Canadians. 1974, Ottawa: Government of Canada
52.
Cheng SH, Chiang TL: The effect of universal health insurance on health care utilization in Taiwan, Results from a natural experiment. JAMA. 1997, 278 (2): 89-93. 10.1001/jama.1997.03550020017009.CrossRefPubMed
53.
Wen CP, Tsai SP, Chung WS: A 10-year experience with universal health insurance in Taiwan: measuring changes in health and health disparity. Ann Intern Med. 2008, 148 (4): 258-267.CrossRefPubMed
54.
Tsai W-C, Kung P-T, Yaung C-L, Li Y-H, Lin S-C: Accessibility to and satisfaction with healthcare by rural area residents. Taiwan J Public Health. 2006, 25 (5): 394-404.
55.
Lu J-FR, Hsieh C-R: An Analysis on the Market Structure and Development of Taiwan’s hospital industry. Taiwan Economic Review. 2003, 31 (1): 107-153.
56.
Kreng VB, Yang CT: The equality of resource allocation in health care under the National Health Insurance System in Taiwan. Health Policy. 2011, 100 (2–3): 203-210.CrossRefPubMed
57.
Buchanan AE: The Right to a Decent Minimum of Health Care. Philosophy & Public Affairs. 1984, 13 (1): 55-78.
58.
Folland ST: Health Care Need, Economics and Social Justice. Int J Soc Econ. 1986, 13: 98-116. 10.1108/eb014009.CrossRef
59.
Ostlin P, Braveman P, Dachs N: Priorities for research to take forward the health equity policy agenda. Bull World Health Organ. 2005, 83 (12): 948-953.PubMedCentralPubMed
60.
Cott CA, Gignac MA, Badley EM: Determinants of self rated health for Canadians with chronic disease and disability. J Epidemiol Community Health. 1999, 53 (11): 731-736. 10.1136/jech.53.11.731.PubMedCentralCrossRefPubMed
61.
Rein M: Social class and the utilization of medical care services: a study of British experience under the National Health Service. Hospitals. 1969, 43 (13): 43-54.PubMed
62.
63.
Brock G: Braybrooke on Needs. Ethics. 1994, 104 (4): 811-823. 10.1086/293656.CrossRef
Metadata
Title
Vertical equity of healthcare in Taiwan: health services were distributed according to need
Authors
Shiow-Ing Wang
Chih-Liang Yaung
Publication date
01-12-2013
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2013
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/1475-9276-12-12

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