Estimation of lifetime productivity loss from patients with chronic diseases: methods and empirical evidence of end-stage kidney disease from Taiwan.

OBJECTIVE: Studies that examine the broad allocation of resources, regardless of who bears the costs, should ideally estimate costs from a societal perspective. We have successfully integrated survival rates, employment ratios, and earnings to address the significant challenge of evaluating societal value through productivity assessments of patients with end-stage kidney disease (ESKD) in Taiwan. METHODS: Using a theoretical framework, we interconnected two nationwide databases: the Taiwan National Health Insurance (NHI) and the Taiwan Mortality Registry from 2000 to 2017. Due to the statutory retirement age of 65, we collected data on all patients (83,358) aged 25-64 years diagnosed with ESKD and undergoing maintenance dialysis. We estimated the lifetime survival function through a rolling extrapolation algorithm, which was then combined with the monthly employment ratio and wages to calculate the lifetime employment duration and productivity up to the legal retirement age of ESKD patients. These were compared with sex-, age-, and calendar year-matched referents to determine the loss of employment duration and productivity of ESKD patients. RESULTS: ESKD patients experienced a loss of approximately 25-56% in lifetime employment duration and a larger loss of about 32-66% in lifetime productivity after adjustments for different age, sex, and calendar year. The annual productivity loss per male (female) ESKD patient relative to that of the age-and calendar year-matched referent ranges from 75.5% to 82.1% (82.3% to 90.3%). During the periods when they are able to work (over the on-the-job duration) male ESKD patients lose between 34 and 56% of their income, and female ESKD patients lose between 39 and 68% of their income, compared to the age-and calendar year-matched referents. The loss of lifetime productivity is a combination of reduced lifetime employment duration, functional disability, absenteeism, and presenteeism at the workplace. The loss related to presenteeism is implied by the reduced wages. CONCLUSIONS: In addition to the loss of employment duration, we have empirically demonstrated the lifetime loss of productivity in patients with ESKD, also indicating the "presenteeism" resulted from inability to perform their job with full capacity over long-term periods.

Losses of lifetime employment duration and productivity for patients with different subtypes and stages of lung cancer.

BACKGROUND: How different subtypes and stages of lung cancer affect morbidity- and mortality-associated productivity have not been investigated. This study quantified the losses of lifetime employment duration and productivity among patients with various subtypes and stages of lung cancer. METHODS: We identified nationwide lung cancer patients diagnosed at the ages of 50-64 between 2011 and 2019. Monthly survival probabilities were weighted by monthly employed-to-population ratios and working salaries to estimate lifetime employment duration and productivity. We compared lifetime employment duration and productivity of patients with those of the age-, sex-, calendar year-matched general population for losses of lifetime employment duration and productivity, which were multiplied by pathology and stage shifts based on the first-round screening of Taiwan Lung Cancer Screening in Never Smoker Trial (TALENT) to calculate the savings of lifetime employment duration and productivity. RESULTS: Lung cancer patients had shorter survival and employment duration than the referents. Patients with lung cancers other than adenocarcinoma experienced greater losses of lifetime employment duration and productivity as compared to adenocarcinoma patients. Applying the estimations of never-smoking patients to 100 lung cancer patients with pathology and stage shifts based on the TALENT, the savings of lifetime employment duration and productivity were 132.2 (95% prediction interval: 116.2-147.4) years and 3353 (95% prediction interval: 2914-3802) thousand US dollars, respectively. CONCLUSIONS: Early diagnosis of lung cancer would save the losses of employment duration and lifetime productivity. Future evaluation of the cost-effectiveness of lung cancer screening could consider incorporating these societal impacts.

Losses of Life Expectancy and Productivity Associated with COVID-19 Pandemic in Canada: Policy Implication for Future Communicable Disease Control.

This research examines whether the Coronavirus disease 2019 (COVID-19) did harm to the population's health through comparing the changes in the life expectancy of Canadians with those of Australians over the period from March 2019 to February 2021 by using a difference-in-differences (DID) estimation method. We found that the pandemic did cause differences in life expectancies between Canada and Australia, probably because of different initial control policies for COVID-19. This study uses the indicator of disability-adjusted life years (DALYs) to measure the societal health burden, which was corroborated by estimating temporal productivity loss (TPL) and permanent productivity loss (PPL) based on the human capital approach (HCA) using data from Health Canada. The societal health burden in Canada amounted to 6.493 DALYs per 1000 male persons and 5.316 DALYs per 1000 female persons. The economy's permanent productivity loss was around USD 5.3 billion, while the temporary productivity loss was around USD 3 billion from February 2020 to April 2022. The sum of the above two losses amounted to 0.477% of the GDP in 2019. Swift and decisive decisions at the very early stage of a pandemic can nip contagions in the bud before numbers get out of hand and would be less damaging to people's health and the economy, as seen in Australia, in contrast to what happened in Canada. We thus recommend that such policies plus telecommunication systems in healthcare services be implemented early on to cope with the future outbreak of any emerging infectious diseases such as COVID-19.

Estimating US Earnings Loss Associated with COVID-19 Based on Human Capital Calculation.

Infection with COVID-19 could result in lockdown, quarantine of contacts, absenteeism from work, and temporary productivity loss. This research aims to calculate (1) how the pandemic affects on-the-job probability and earnings for the working population, and (2) how much productivity loss is associated with self or a family member sick with COVID-19. Based on data collected from the U.S Research and Development Survey (RANDS), this research projects the relationship between on-the-job possibility and age of the index group and calculates the employment possibilities of the index group relative to the healthy group, namely the employment ratio. The weekly loss of productivity, presented by earnings, associated with COVID-19 for groups aged 18-44 years and 45-64 years was calculated, since the 18- to 64-year-old population is an economy's active workforce. Analytical results indicate that the older the age group, the lower the on-the-job possibility, and the higher the weekly productivity loss due to self or a family member being sick from COVID-19. For the group aged 45-64 years, the employment ratio of the index group relative to the healthy group dropped from 0.863 to 0.39, corresponding to a weekly productivity loss of 136-590 US dollars. The overall impact would be about a 9% loss in GDP. Infected or quarantined people would be confined to working in relatively isolated offices or places to allow for social distancing. Proactive health promotion in the workplace plus reactive work through telecommunication systems would reduce such losses. Such preparedness needs to be implemented early for more vulnerable workers who are of middle or old age and/or those comorbid with diabetes.

The Determinants of Telehealth Provision: Empirical Evidence from OECD Countries.

Health services provided through the telecommunications system aim to improve the population's health and well-being. This research aims to explore what digital, economic, and health factors are associated with the provision of telehealth services, especially in ageing communities. Applying Organization for Economic Cooperation and Development (OECD) countries' experiences, this research tries to construct a logistic regression model between adopting a telehealth system or not, a binary outcome variable, and a group of potentially explanatory variables. Estimation results showed that there were thresholds for telehealth provision: The demand for telehealth service usually began when the provision of telecommunication accessibility reached 50%, the proportion of elders exceeded 10%, or the proportion of health spending occupied more than 3-5% of the gross domestic product (GDP); the slope of each variable seemed to correspond with an increase in demand for such a provision. A growing number of individuals in OECD countries are now readily served by telehealth systems under the COVID-19 pandemic. These findings could be regarded as a model for other countries for implementing the necessary infrastructure early on when any of these parameters reaches its threshold. Moreover, telehealth applied in developing countries could be elevated for wider populations to access basic health services and for the remote delivery of health care. A rational decision could be made to appropriately use additional resources in telehealth provision. With accessible e-health services, the population's health could be improved, which in turn would possibly increase productivity and social welfare.

Investing preventive care and economic development in ageing societies: empirical evidences from OECD countries.

BACKGROUND: The proportion of the elderly aged 65 years old or above will reach 16% in 2050 worldwide. Early investment in effective prevention would generally reduce the morbidity, complication, functional disability, and mortality of most chronic illnesses and save resources in both healthcare and social services. This research aims to investigate how the optimal allocation of medical resources between prevention and treatment adds value to the population's health as well as examine the interaction between ageing, health, and economic performance. METHODS: This research undertakes ageing-health analyses by developing an economic growth model. Based on the Organization for Economic Co-Operation and Development (OECD) countries' experiences over the period from 2000 to 2017, this research further examines the hypothesis that an ageing society could increase demand for preventive and curative healthcare. RESULTS: Theoretical analysis found that the prevention share for maximizing growth is the same as that for minimizing ill health and maximizing welfare; this share increases with treatment share and ageing ratios. Estimation results from OECD countries' experiences indicate that when treatment share increases by 1%, the prevention demand increases by 0.036%. A one-percent increase in the ageing ratio yields a change in prevention share of 0.0368%. The optimal share of prevention health expenditure to GDP would be 1.175% when the prevalence rate of ill health isat 6.13%; a higher or lower share of prevention would be accompanied with a higher prevalence of ill health. For example, a zero and 1.358% preventive health expenditure would be associated with an 18.01% prevalence of ill health, while the current share of prevention of 0.237% is associated with a 10.26% prevalence of ill health. CONCLUSION: This study shows that appropriate prevention is associated with decreases in the prevalence rates of ill health, which in turn attains sustainable growth in productivity. Too much prevention, however, could lead to higher detection of new chronic diseases with mild severity, which would result in longer illness duration, and higher prevalence rates of ill health. With suitable allocation of medical resources, the economic growth rate will help to cancel out increases in healthcare spending for the elderly and for expenses needed for the improvement of the population's health as a whole.

Estimated Loss of Lifetime Employment Duration for Patients Undergoing Maintenance Dialysis in Taiwan.

BACKGROUND AND OBJECTIVES: An accurate estimate of the loss of lifetime employment duration resulting from kidney failure can facilitate comprehensive evaluation of societal financial burdens. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: All patients undergoing incident dialysis in Taiwan during 2000-2017 were identified using the National Health Insurance Research Database. The corresponding age-, sex-, and calendar year-matched general population served as the referents. The survival functions and the employment states of the index cohort (patients on dialysis) and their referents for each age strata were first calculated, and then extrapolated until age 65 years, where the sum of the product of the survival function and the employment states was the lifetime employment duration. The difference in lifetime employment duration between the index and referent cohort was the loss of lifetime employment duration. Extrapolation of survival function and relative employment-to-population ratios were estimated by the restricted cubic spline models and the quadratic/linear models, respectively. RESULTS: A total of 83,358 patients with kidney failure were identified. Men had a higher rate of employment than women in each age strata. The expected loss of lifetime employment duration for men with kidney failure was 11.8, 7.6, 5.7, 3.8, 2.3, 1.0, and 0.2 years for those aged 25-34, 35-40, 41-45, 46-50, 51-55, 56-60, and 61-64 years, respectively; and the corresponding data for women was 10.5, 10.1, 7.9, 5.6, 3.3, 1.5, and 0.3 years, respectively. The values for loss of lifetime employment duration divided by loss of life expectancy were all >70% for women and >88% for men across the different age strata. The sensitivity analyses indicated that the results were robust. CONCLUSIONS: The loss of lifetime employment duration in patients undergoing dialysis mainly originates from loss of life expectancy.

The association between economic indicators and the incidence of tetraplegia from traumatic spinal cord injury in Taiwan.

BACKGROUND: Economic performance may affect public health parameters. This study aimed to determine the time trend of incidence of traumatic spinal cord injury (SCI) and its association with income, presented by GDP (gross domestic product) per capita. METHODS: This study was a retrospective observational study in Taiwan. Newly diagnosed SCI patients with moderate to severe disability from 2002 to 2015 were identified from the reimbursement database of the National Health Insurance (NHI) system (1998-2015). CIR16-99 (cumulative incidence rate, aged 16-99 years, per 103 person-years) and CIR16-59 (aged 16-59 years) of SCI from 2002 to 2015 were measured. RESULTS: There were 5048 newly diagnosed SCI patients during the study period. After controlling the factors of sex, urbanization level, literacy, income inequality, and global financial crisis (mixed effects models), the CIR16-99 of SCI, traumatic SCI, motor vehicle (MV)-related SCI, fall-related SCI, tetraplegia, traumatic tetraplegia, MV-related tetraplegia, and fall-related tetraplegia were inversely associated with GDP per capita; the ß coefficients ranged from - 4.85 (95% confidence interval - 7.09 to - 2.6) for total SCI to - 0.8 (- 1.3 to - 0.29) for fall-related tetraplegia. We restricted our comparison to Taipei City and the 4 lowest densely populated counties, which also corroborated with the above results. The income elasticity analysis revealed when GDP per capita increased by 1%, the total SCI decreased by 1.39‰; which was also associated with a decrease of 1.34‰, 1.55‰, 1.36‰, 1.46‰, 1.54‰, 1.54‰, and 1.62‰ for traumatic SCI, MV-related SCI, fall-related SCI, tetraplegia, traumatic tetraplegia, MV-related tetraplegia, and fall-related tetraplegia respectively. The ß coefficients show that the compared areas of urbanization level were also inversely correlated with CIR16-59 in the SCI population. CONCLUSIONS: We conclude that the incidence of tetraplegia of traumatic SCI in Taiwan decreases with good economic performance, which may be resulted from the provision of public goods and services, possibly through improvements in the infrastructure of transportation and construction.

Savings of loss-of-life expectancy and lifetime medical costs from prevention of spinal cord injuries: analysis of nationwide data followed for 17 years.

BACKGROUND: The objectives of this research were to determine the savings of loss-of-life expectancy (LE) and lifetime medical costs (LMC) from prevention of spinal cord injuries (SCI) in Taiwan. METHODS: From the claims database of Taiwan National Health Insurance, we identified 6164 adult patients with newly diagnosed SCI with permanent functional disability from 2000 to 2015 and followed them until the end of 2016. We estimated survival function through the Kaplan-Meier method and extrapolated it to lifetime. RESULTS: For the SCI cohort, the LE and loss-of-LE were 17.6 and 13.3 years, respectively, while those for SCI with coding of external causes (E-code) were 18.1 and 13.0 years, respectively. For the SCI cohort with E-code, the loss-of-LE of motor vehicle (MV)-related SCI was significantly higher than that of fall-related SCI. In young and middle-aged patients with SCI with E-code, the loss-of-LE of MV-related paraplegia was significantly higher than that of MV-related quadriplegia and fall-related SCI. With a 3% discount rate, the LMC for patients with SCI after diagnosis were US$82 772, while those for patients with SCI with E-code were US$81 473. The LMC and the cost per year for those living with quadriplegia were significantly higher than those for paraplegia in all age groups, possibly related to the higher frequencies of stroke, chronic lung disease and dementia. CONCLUSIONS: We conclude that quadriplegia has a higher impact on medical costs than paraplegia, and MV-related SCI has a higher impact on loss-of-LE than fall-related SCI. We recommend comprehensive SCI prevention be established, including infrastructures of construction and transportation.

Mapping Regional Well-Being in the Universal Health Coverage System in Taiwan.

PURPOSE: Regarding the universal health coverage (UHC) goal of eliminating health disparity, this study seeks to examine whether this objective has actually been achieved and whether residence affects health and well-being inequality. METHODS: Based on Taiwan's experience with its UHC system, this research quantifies health and well-being indicators, including quality-adjusted life expectancy (QALE), consumption, and utility-adjusted life expectancy (UALE), and uses the geographic information system (GIS) to map regional well-being throughout Taiwan. Using spatial lag regressions, this study estimates how residence and socio-economic factors affect population's well-being. RESULTS: Estimation results indicate a 1‰ increase in the mortality rate reduces the population's UALE by 0.4131 utility-adjusted life-years (UALYs). The differences in health and well-being indicators between urban and rural residents were 6.49 quality-adjusted life-years (QALYs) and 3.84 UALYs. Residents living in Taipei City had the highest level of QALE, consumption, and well-being, and those in Taitung County had the lowest level of QALE and well-being. The regional spatial autocorrelation results show that a population's health status and well-being are connected to residence. CONCLUSION: Our estimation results show that risk of higher mortality rates in disadvantaged areas appears to be associated with well-being inequality, even with universal healthcare coverage. We suspect that related health intervention efforts, such as preventive and curative medical devotion, in Taiwan might not have effectively reached more rural residents, and thus recommend more work be undertaken to reduce mortality rates in these communities.

The roles of preventive and curative health care in economic development.

INTRODUCTION: Both the preventive and curative healthcare provisions accumulate agents' health stock and stimulate economies' productivities. However, with limited medical resources, increases in preventive health expenditure crowd out curative expenditure, and vice versa, which in turn impairs the population's health and deters economic growth. This research aims to provide a empirically rigorous test on the hypothesis that optimally allocating health expenditure between prevention and cures stimulates economic growth within different countries, especially developed countries, and investigates whether health services are luxury goods on the path of economic development. METHODS: Based on OECD country experiences, this present study uses the system generalized method of moments (GMM) estimation method to examine the roles of preventive and curative healthcare services over the path of economic development and proves that preventive and curative health spending have non-linear effects on economic performance. RESULTS: For growth maximization, the optimal share of preventive health expenditure to GDP is 0.44% with per capita GDP at US$40,465; the real share is 0.25% with per capita GDP at US$35,230. The optimal share of curative health expenditure to GDP is 10.96% with per capita GDP at US$41,816; the real share is 8.26% with per capita GDP at US$35,230. Accordingly, the estimated optimal provision of health services are currently underprovided. This research further estimates the effects of income on demand for care and shows that the income elasticities of preventive and curative health care are greater than unity. Health services are luxury goods. CONCLUSIONS: Economies with higher incomes demand such services more than those with lower incomes. The large positive effects of income on preventive care use exist.

Universal health insurance, health inequality and oral cancer in Taiwan.

INTRODUCTION: The introduction of universal health insurance coverage aims to provide equal accessibility and affordability of health care, but whether such a policy eliminates health inequalities has not been conclusively determined. This research aims to examine the healthcare outcomes of oral cancer and determine whether the universal coverage system in Taiwan has reduced health inequality. METHODS: Linking the databases of the National Cancer Registry with the National Mortality Registry in Taiwan, we stratified patients with oral squamous cell carcinoma by gender and income to estimate the incidence rate, cumulative incidence rate aged from 20 to 79 (CIR20-79), life expectancy, and expected years of life lost (EYLL). The difficulties with asymmetries and short follow-up periods were resolved through applying survival analysis extrapolation methods. RESULTS: While all people showed a general improvement in life expectancy after the introduction of the NHI, the estimated change in EYLL's of the high-, middle-, and low-income female patients were found to have +0.3, -0.5 and -7 years of EYLL, respectively, indicating a reduction in health inequality. Improvements for the male patients were unremarkable. There was no drop in the CIR20-79 of oral cancer in disadvantaged groups as in those with higher incomes. CONCLUSIONS: Universal coverage alone may not reduce health inequality across different income groups for oral cancer unless effective preventive measures are implemented for economically disadvantaged regions.

Health expenditures spent for prevention, economic performance, and social welfare.

BACKGROUND: Countries with limited resources in economic downturns often reduce government expenditures, of which spending on preventive healthcare with no apparent immediate health impact might be cut down first. This research aims to find the optimum share of preventive health expenditure to gross domestic product (GDP) and investigate the implications of preventive health services on economic performance and the population's wellbeing. METHODS: We develop the economic growth model to undertake health-economic analyses and parameterize for Taiwan setting. Based on the US experiences over the period from 1975 to 2013, this research further examines the model's predictions on the relationship between preventive health expenditure and economic performance. RESULTS: Theoretical analysis and numerical simulations show that an inverse U-shaped relationship exists between the proportion of GDP spent on prevention and social welfare, as well as between the proportion spent on prevention and economic growth. Empirical analysis shows an under-investment in prevention in Taiwan. The spending of preventive healthcare in Taiwan government was 0.0027 GDP in 2014, while the optimization levels for economic development and social welfare would be 0 · 0119 and 0 · 0203, respectively. There is a statistically significant nonlinear relationship between health expenditure on prevention and the estimated real impact of economic performance from US experiences. The welfare-maximizing proportion of preventive expenditure is usually greater than the proportion maximizing economic growth, indicating a conflict between economic growth and welfare after a marginal share. CONCLUSION: Our findings indicate that it is worthwhile increasing investment on prevention up until an optimization level for economic development and social welfare. Such levels could also be estimated in other economies.

Continuing Medical Education via Telemedicine and Sustainable Improvements to Health.

Background. This research aims to investigate the quantitative relationship between telemedicine and online continuing medical education (CME) and to find the optimal CME lectures to be delivered via telemedicine to improve the population's health status. Objective. This study examines the following: (1) What factors foster learning processes in CME via telemedicine? (2) What is the possible role of online CME in health improvement? And (3) How optimal learning processes can be integrated with various health services? Methods. By applying telemedicine experiences in Taiwan over the period 1995-2004, this study uses panel data and the method of ordinary least squares to embed an adequate set of phenomena affecting the provision of online CME lectures versus health status. Results. Analytical results find that a nonlinear online CME-health nexus exists. Increases in the provision of online CME lectures are associated with health improvements. However, after the optimum has been reached, greater provision of online CME lectures may be associated with decreasing population health. Conclusion. Health attainment could be partially viewed as being determined by the achievement of the appropriately providing online CME lectures. This study has evaluated the population's health outcomes and responded to the currently inadequate provision of online CME lectures via telemedicine.

More Health Expenditure, Better Economic Performance? Empirical Evidence From OECD Countries.

Recent economic downturns have led many countries to reduce health spending dramatically, with the World Health Organization raising concerns over the effects of this, in particular among the poor and vulnerable. With the provision of appropriate health care, the population of a country could have better health, thus strengthening the nation's human capital, which could contribute to economic growth through improved productivity. How much should countries spend on health care? This study aims to estimate the optimal health care expenditure in a growing economy. Applying the experiences of countries from the Organization for Economic Co-Operation and Development (OECD) over the period 1990 to 2009, this research introduces the method of system generalized method of moments (GMM) to derive the design of the estimators of the focal variables. Empirical evidence indicates that when the ratio of health spending to gross domestic product (GDP) is less than the optimal level of 7.55%, increases in health spending effectively lead to better economic performance. Above this, more spending does not equate to better care. The real level of health spending in OECD countries is 5.48% of GDP, with a 1.87% economic growth rate. The question which is posed by this study is a pertinent one, especially in the current context of financially constrained health systems around the world. The analytical results of this work will allow policymakers to better allocate scarce resources to achieve their macroeconomic goals.

Measuring adjusted quality of life in telemedicine.

OBJECTIVE: This research uses the quality-adjusted life expectancy (QALE) method to assess the QALE changes of rural residents before and after introducing telemedicine health services. MATERIALS AND METHODS: Based on Taiwan's experiences of telemedicine provision over the period 1995-2004, this representative of a national sample is composed of 85 cases for people living in Penghu County, a remote area in Taiwan. Cases were evaluated using persons with life expectancy at birth from 85 to 0 years. RESULTS: The provision of telemedicine health services increased rural population QALE by 2.91 quality-adjusted life years. Telemedicine provision does improve rural residents' health status. Relative to the index population living in Taipei, the capital of Taiwan, the survival ratios of the population of concern >65 years decreased faster and were less than those of the index population >65 years by at least 7% and 3%, respectively, before and after introducing telemedicine health services. CONCLUSIONS: It appears that the needs for telemedicine health services increased along with the aging of our society in rural and underserved regions.

Economic evaluations of the effects of longevity on telemedicine and conventional healthcare provision.

OBJECTIVE: Providing healthcare for the elderly is one of the expectations of a telemedicine system to reduce the isolation of the aging and enhance the quality of long-term care for the elderly. Based on the experiences in Taiwan, this research aimed at investigating the influences of longevity on the demand for health services through telecommunications and conventional face-to-face methods and to note the relationship between telemedicine and conventional health services. MATERIALS AND METHODS: Multiple regression analysis was undertaken. The sample covers the period from 1995 to 2004. Our results indicate that a 1% increase in the proportion of elderly relative to the population significantly increases the quantity demanded of telehealth by 305.73 and the quantity demanded of face-to-face health services by 1.99 × 107. On the relationship between longevity and telemedicine, the society begins to request telehealth when the elderly proportion is >2.06%. With current 9.5% elderly proportion, there is a potential to provide 2,274.86 telemedicine health services that are currently provided at only 954.9 and underprovided by 1.38 times. On the relationship between longevity and conventional health services, when the elderly proportion is >0.56%, the needs for face-to-face health services increase in the elderly percentage. With 9.5% elderly proportion, the estimated volume of health services via conventional medical care system is 1.54 × 108. The current quantity of such services is 1.11×108 and underprovided by 38%. Estimation results reveal that online and conventional health services are complementary for enhancing health status in an aging society.

The role of cost in telemedicine evaluation.

This study examined how health service provision via telemedicine and conventional medical systems affected a population's health status and whether the costs of health services play a deterministic role in allocating medical resources. Using the health indicator of the life expectancy at birth and applying the generalized methods of moments estimators in version 10.0 of the statistical software STATA by blending statistics and data with the survey data, the panel datasets of observations were covered over the period 1995-2004 for the Taiwan experience. Empirical evidence indicated that a 10% increase in the cost of each conventional health service increased the population life expectancy at birth by 0.12%. A 10% increase in gross domestic product per capita or the income level of the country increased the population's life expectancy at birth by 0.0023%. A 10% increase in population increased the population's life expectancy at birth by 0.0004%. A 10% increase in the ratio of telehealth services relative to conventional medical services increased the population's life expectancy at birth by 0.00019%. Interestingly, the cost of each telehealth service does not influence the population's health status. Furthermore, to reach the longevity at 76.25 years that is the current population's life expectancy at birth, an increase in health services via the telecommunications system of 243 times is able to reduce the cost of conventional health services by 69.5%. Accordingly, the cost of telehealth services does not play a deterministic role for guiding medical resource allocation and the provision of telemedicine is able to effectively save medical resources.

The influence of economic performance on telemedicine provision.

Based on the experiences of Taiwan, this study aims to examine how country-level economic performance affects the provision of healthcare through telecommunications systems and how these health services influence individual-level health status. Regression analysis is undertaken and an ordinary least-squares method is applied. A panel dataset consists of a national sample over the period from 1995 to 2004. Empirical evidences show that increases in gross domestic product (GDP) increase the reported demand for telemedicine, but the price (cost) of telemedicine reduces that demand. In contrast, the price of conventional medical care and the indicator of healthcare environment (per capita national health expenditure) have no impact on the demand for telemedicine. The study provides quantitative estimates of the impact of GDP and telemedicine prices on the reported demand for telemedicine. A 10% increase in GDP increases the demand for telemedicine services by 3.9%. A 10% increase in the price of telemedicine reduces the demand for telemedicine by 7.4%. Furthermore, Taiwan's current GDP is used to estimate the unmet demand for telemedicine. The estimated current unmet demand for telemedicine is more than three times that currently being provided. In a well-run tele-healthcare system, the residents' capacities to generate income result in their health status being enhanced. Eventually, the economy will enjoy a higher level of welfare due to the impact of health and the provision of telemedicine. This is possibly a much more important source of economic performance and is derived from a policy aimed at promoting telemedicine.