The ecology of medical care in Taiwan

In regular administrative statistics for medical services, utilization data are usually presented as aggregate data and lack an individual perspective. The aim of this study was to provide an overview of medical care utilization in Taiwan using a long-established analytical framework, the so-called ecology model.

Claims data for a cohort of one million people from the National Health Insurance (NHI) Research Database were used to estimate the yearly and monthly prevalence of health care utilization in Taiwan in 2005. Analyses were extended to different types of healthcare settings and were stratified by age and sex. Results are presented per 1000 of the population.

Per 1000 people, 74 did not utilize any NHI services during the year. In a month, 503 people on average utilized at least once NHI service of any kind, 329 visited a physician's clinic (Western medicine), 152 visited a hospital-based outpatient clinic, 19 visited an emergency department, 10 were hospitalized and 3 were hospitalized in an academic medical center. Women were more likely to utilize NHI services than men (274/504 vs. 229/496 in a month). In a month on average, 40.3% (146/362) of young people, 52.2% (166/318) of middle-aged people, 53.3% (121/227) of children and 75.0% (70/93) of elderly people utilized NHI services. Over the whole year, 22.0% (21/93) of elderly people were hospitalized and nearly one-third of them were hospitalized in academic medical centers.

People in Taiwan utilized NHI services frequently and tended to seek medical help in hospitals. Although these features might reflect the higher availability and accessibility of medical care within the NHI in Taiwan, the possibility of overuse deserves further attention.