The Impact of Pharmaceutical Home Care on Medical Utilization for Frequent Users of Outpatient Services in Taiwan.

Chien-Ying Lee,Kuang-Hua Huang,Yung-Rung Lai,Tung-Han Tsai,Heng-Hsuan Su,Yu-Chia Chang

doi:10.3390/ijerph18147336

Abstract

Due to the high-accessibility and low-copayment of healthcare system in Taiwan, the clinical visit frequency of people is relatively high, which often leads to an excessively high healthcare expenditure. The aim of this research was to explore the effectiveness of pharmaceutical home care for frequent users of outpatient service and to analyze the impact of pharmaceutical home care on medical utilization. The study was based on the Taiwan National Health Insurance Research Database. Patients with over 100 clinical visits during 2010 to 2012 were selected as subjects. Whether these patients participate the experimental plan of pharmaceutical home care in the following year and the medical utilization of the research subjects were analyzed to compare the difference between participating group and non-participating group in this plan. The generalized estimating equation was employed to examine the difference of medical utilization. A total of 3943 subjects were included in this study, including 591 patients (14.99%) participating in the experimental plan. The average number of physician visits during the following year of the participating group was higher than that of the non-participating group by 0.12 visits, and the outpatient medical expense was lower than the non-participating group by 18,302 points (1 point = 0.03 US dollars). After participating in the plan, the average number of clinical visits of frequent users of outpatient services was significantly reduced by 6.63 visits, and the outpatient expense was significantly decreased by 9871 points. After joining the experimental plan of pharmaceutical home care, the average number of outpatient visits decreased significantly and the medical expense was lower when compared with those who did not participate in the plan.

Highlights

The aims of this research are to analyze the characteristics of frequent users of outpatient services, to explore the effectiveness of frequent users of outpatient services participating in the experimental plan of pharmaceutical home care, and to analyze the impact of pharmaceutical home care on medical utilization for frequent users of outpatient services
A total of 3943 frequent users of outpatient services were eligible to be included in the pharmaceutical home care pilot program
The results indicated that the average outpatient medical expense points of patients in the participating group was 81,269 points less than that of non-participating group

Summary

Introduction

In Taiwan, the National Health Insurance (NHI) program was introduced in 1995 [1]. The NHI system provides medical insurance coverage for people, with nearly the whole of Taiwan’s population having been covered with comprehensive insurance [2]. NHI was associated in a reduction in mortality rate and considered to be amenable to health care, among those uninsured people less likely to have medical insurance previously [2]. Literatures have different definitions of patients with high frequency visits.

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Discussion

Conclusion