[Published Article] Is there a disparity in the hospital care received under a universal health insurance program in Taiwan?

Is there a disparity in the hospital care received under a universal health insurance program in Taiwan?

Yu-Yu Hsiao, Shou-Hsia Cheng

International Journal for Quality in Health Care (in press)

Abstract

Objective To analyze the disparity in hospital care among people of various socio-economic status (SES) under a universal health insurance scheme. Design A questionnaire survey mailed to discharged patients in October 2010. Setting This study included 183 large-scale hospitals in Taiwan. Participants A total of 3015 patients/caregivers completed the questionnaires, which yielded a response rate of 58%. Main Outcome Measures Three variables were included. The two access-to-care variables were admission route and accreditation level of the hospital in which the patient stayed. A structured questionnaire, the Patient-Reported Hospital Quality (PRHQ), was included to characterize patient’s experience of hospital stay. Results Patients with lower education were less likely to be admitted to a hospital according to a planned schedule, or to choose an academic medical center hospital. However, SES was not associated with the PRHQ scores. Furthermore, patients with unplanned admission were associated with lower PRHQ scores than those with planned admission to the hospital. Conclusions Under the universal health insurance system in Taiwan, lower education is associated with unplanned admission to a hospital, which might result in poorer perceived quality of care. Reducing unplanned admission is a challenge for health authorities in the future.

Keywords access to care, quality of care, hospital, socioeconomic status, Taiwan

Submitted: 11-22-2011
Revised: 02-20-2012
Accepted: 01-15-2013


(註記)
第一篇發表在英文期刊上，同時也是列為第一作者的文章。投稿到接受中間花了一年多的時間，但其實占了比較多時間的是在resubmitted到accepted的這段時間，長達一年。比較有趣的是，resubmitted之後我們等了半年多都沒等到回應，寫了幾封e-mail之後竟然才收到文章進行審查的e-mail。好在後來的過程還算順遂，沒有甚麼大問題就被接受了。