Health Behaviors and Health Status among Middle-Aged and Older Adults with Chronic Diseases in Taiwan.

Changes in lifestyle behaviors may effectively maintain or improve the health status of individuals with chronic diseases. However, such health behaviors adopted by individuals are unlikely to demonstrate similar patterns. This study analyzed the relationship between the heterogeneous latent classes of health behavior and health statuses among middle-aged and older adults with hypertension, diabetes, or hyperlipidemia in Taiwan. After selecting 2103 individuals from the 2005 and 2009 Taiwan National Health Interview Survey (NHIS), we first identified heterogeneous groups of health behaviors through latent class analysis (LCA). We further explored the relationship between each latent class of health behavior and health status through ordered logit regression. We identified the following five distinct health behavior classes: the all-controlled, exercise and relaxation, healthy diet and reduced smoking or drinking, healthy diet, and least-controlled classes. Regression results indicated that individuals in classes other than the all-controlled class all reported poor health statuses. We also found great magnitude of the coefficient estimates for individuals who reported their health status to be poor or very poor for the least-controlled class. Therefore, health authorities and medical providers may develop targeted policies and interventions that address multiple modifiable health behaviors in each distinct latent class of health behavior.

Patients with minor diseases who access high-tier medical care facilities: New evidence from classification and regression trees.

OBJECTIVES: Patients in Taiwan's National Health Insurance (NHI) program can choose a medical care facility of any tier for outpatient visits, without a referral. However, this system results in high medical expenditures and costs of outpatient visits. In this study, patients who had only minor diseases but who accessed high-tier medical care facilities were investigated using classification and regression trees. METHODS: For this study, data were obtained from the Taiwan NHI Research Database. First, 280 diseases, coded according to the Clinical Classification Software (CCS), were examined to determine whether patients chose the most appropriate facility when seeking medical care. After controlling for the CCS codes, an investigation into the types of patients who visit high-tier medical care facilities was conducted. RESULTS: Chronic disease status and CCS code were critical for constructing the classification trees. Male patients living in urban areas and earning a higher income were more likely to access high-tier medical care facilities. However, changes to the NHI copayment policies have significantly reduced the probability of utilizing high-tier medical care facilities. CONCLUSIONS: Factors relevant to patients' selection of high-tier medical care facilities were identified. Overall, increasing patients' out-of-pocket payments significantly reduced the probability of accessing high-tier medical facilities.

Measuring inequality in physician distributions using spatially adjusted Gini coefficients.

OBJECTIVE: To measure inequality in physician distributions using Gini coefficient and spatially adjusted Gini coefficients. DESIGN: Measurements were based on the distribution of physician data from the Taiwan National Health Insurance Research Database (NHIRD) and population data from the Ministry of the Interior in Taiwan. SETTINGS: The distribution of population and physicians in Taiwan from 2001 to 2010. PARTICIPANTS: This study considered 35 000 physicians who are registered in Taiwan. MAIN OUTCOME MEASURES: To calculate the Gini coefficient and spatially adjusted Gini coefficients in Taiwan from 2001 to 2010. RESULTS: The Gini coefficient for each year, from 2001 to 2010, ranged from 0.5128 to 0.4692, while the spatially adjusted Gini coefficients based on travel time and travel distance ranged, respectively, from 0.4324 to 0.4066 and from 0.4408 to 0.4178. We found that, in each year, irrespective of the type of spatial adjustment, the spatially adjusted Gini coefficient was smaller than the Gini coefficient itself. Our empirical findings support that the Gini coefficient may overestimate the maldistribution of physicians. CONCLUSIONS: Our simulations demonstrate that increasing the number of physicians in medium-sized cities (such as capitals of counties or provinces), and/or improving the transportation time between medium-sized cities and rural areas, could be feasible solutions to mitigate the problem of geographical maldistribution of physicians.

The relationship between depressive symptoms and health service utilization for elderly people in Taiwan.

OBJECTIVE: This study analyzes the relationship between depressive symptoms and the utilization of medical services for elderly people in Taiwan. METHODS: Because depressive symptoms and physical health may have a reciprocal relationship, a simultaneous equations model was used by performing a 3-stage least squares (3SLS) regression. The data in this study were obtained from the 2003 Survey of Health and Living Status of the Elderly in Taiwan (SHLSE). RESULTS: The findings show that depressive symptoms have a significantly negative effect on the utilization of outpatient, inpatient, and emergency services. Furthermore, the magnitude of the 3SLS estimates of physical health status in relation to health service utilization is substantially greater than that in the OLS estimates. The results may reveal that people with depressive symptoms may seek healthcare services because of physical discomfort. CONCLUSIONS: Those with depressive symptoms may not seek specialty mental treatments, suggesting that policy interventions to monitor the need to care for elderly people with depressive symptoms through primary care services are important in screening and maintaining the mental health of elderly people.