Abstract

BackgroundIn Taiwan, the policy of catastrophic illness certificates has benefited some populations with specific diseases, but its effect on the use of medical services and the sequence of public health has not been examined. As a pilot of a series of studies, focused on emergency department (ED) visits, the present study aimed to compare medical utilization and various diagnostic categories at EDs between the elderly with an identified catastrophic illness and the elderly without.MethodsA cross-sectional study, based on a large-sample nationwide database (one million of the population, randomly sampled from Taiwan’s National Health Insurance Research Database (NHIRD)), was performed in Taiwan. The 2008 insurance records of ambulatory medical services for subjects aged 65 years or more among the above one million of the population were further selected and analyzed. Taiwan’s registered catastrophic illness dataset for 2008 was linked in order to identify the target subgroup.ResultsThe prevalence of certificated catastrophic illness in Taiwan’s elderly utilizing ambulatory medical services was 10.16%. On average, 61.62 emergency department (ED) visits/1,000 persons (95% CI: 59.22–64.01) per month was estimated for the elderly Taiwanese with catastrophic illness, which was significantly greater than that for the elderly without a catastrophic illness (mean 33.53, 95% CI: 32.34–34.71). A significantly greater total medical expenditure for emergency care was observed in the catastrophic illness subgroup (US$145.6 ± 193.5) as compared with the non-catastrophic illness group (US$108.7 ± 338.0) (p < 0.001). The three most common medical problems diagnosed when visiting EDs were injury/poisoning (14.22%), genitourinary disorders (11.26%) and neoplasm-related morbidity (10.77%) for the elderly population with a catastrophic illness, which differed from those for the elderly without a catastrophic illness.ConclusionsIn Taiwan, the elderly with any certificated catastrophic illness had significantly more ED visits and a higher ED medical cost due to untypical medical complaints.

Highlights

  • In Taiwan, the policy of catastrophic illness certificates has benefited some populations with specific diseases, but its effect on the use of medical services and the sequence of public health has not been examined

  • A study analyzing the correlation between National Health Insurance (NHI)-defined catastrophic illness and high medical expenditure revealed that those with catastrophic illness tended to be socio-economically vulnerable and usually had a high medical expenditure [2]

  • The National Health Research Institute (NHRI) safeguards the privacy and confidentiality of those included in the database and routinely transfers health insurance data from the National Health Insurance Bureau (NHIB) to enable health researchers to analyze and improve the health of Taiwan’s citizens

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Summary

Methods

Security, and quality control of data Taiwan launched a single-payer National Health Insurance (NHI) Program on March 1, 1995. The NHI database contains registration files and original claims data for reimbursement, and access to the National Health Insurance Research Database (NHIRD), which was derived from this system by the NHIB and is maintained by the NHRI, is provided to scientists in Taiwan for research purposes [7,8,9]. Data protection and permission Data in the NHIRD that could be used to identify patients or care providers, including medical institutions and physicians, is scrambled before being sent to the NHRI for database inclusion, and is further scrambled before being released to each researcher. To study the difference in ED utilization between Taiwan’s elderly with a catastrophic illness and those without, subjects aged 65 years or older in 2008 were selected and their medical records regarding ambulatory services in 2008 were analyzed. All statistical calculations were performed using the Statistical Package for Social Sciences for Windows (SPSS for Windows 15.0)

Results
Background
Conclusions
21. Tsai HJ
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