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Low acuity paediatric emergency visits under single-payer universal health insurance in Taiwan, 2000-2015: a
I-Anne Huang1,2,3, Yiing-Jenq Chou3, I-Jun Chou2,4
1Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan.
Insights
Pediatric emergency department visits for low-acuity conditions remained stable in Taiwan between 2000 and 2015. Factors like child
Area of Science:
- Public Health
- Health Services Research
- Pediatrics
Background:
- Emergency department (ED) utilization is a key policy concern, particularly for pediatric low-acuity (LA) visits.
- Understanding trends in pediatric ED use is crucial for resource allocation and healthcare system planning.
Purpose of the Study:
- To analyze trends in pediatric ED and LA ED visits in Taiwan under a universal health insurance program.
- To identify factors associated with potentially unnecessary pediatric ED utilization.
Main Methods:
- Population-based, repeated cross-sectional design using National Health Insurance claims data (2000, 2005, 2010, 2015).
- Analysis of individuals aged 18 years and under.
- Definition of LA pediatric ED visits using diagnosis and severity classification systems.
- Generalized estimating equation used to identify associated factors.
Main Results:
- Annual LA pediatric ED visits per 100 children decreased by 12.40% from 2000 to 2015.
- Infectious ear, nose, throat, dental, and mouth diseases were the primary reasons for LA visits.
- Physical trauma-related LA visits increased significantly.
- Increased likelihood of LA visits correlated with child's age and lower family socioeconomic status.
Conclusions:
- Despite universal health insurance, pediatric ED utilization for LA conditions did not significantly increase in Taiwan.
- Taiwan's experience offers valuable insights for countries considering healthcare reform and managing ED resource allocation.
- Targeted interventions may be needed to address specific drivers of LA pediatric ED visits, such as trauma.
Objectives:
Emergency services utilisation is a critical policy concern. The paediatric population is the main user of emergency department (ED) services, and the main contributor to low acuity (LA) ED visits. We aimed to describe the trends of ED and LA ED visits under a comprehensive, universal health insurance programme in Taiwan, and to explore factors associating with potentially unnecessary ED utilisation.
Design And Setting:
We used a population-based, repeated cross-sectional design to analyse the full year of 2000, 2005, 2010 and 2015 National Health Insurance claims data individually for individuals aged 18 years and under.
Participants:
We identified 5 538 197, 4 818 213, 4 401 677 and 3 841 174 children in 2000, 2005, 2010 and 2015, respectively.
Primary And Secondary Outcome Measures:
We adopted a diagnosis grouping system and severity classification system to define LA paediatric ED (PED) visits. Generalised estimating equation was applied to identify factors associated with LA PED visits.
Results:
The annual LA PED visits per 100 paediatric population decreased from 10.32 in 2000 to 9.04 in 2015 (12.40%). Infectious ears, nose and throat, dental and mouth diseases persistently ranked as the top reasons for LA visits (55.31% in 2000 vs 33.94% in 2015). Physical trauma-related LA PED visits increased most rapidly between 2000 and 2015 (0.91-2.56 visits per 100 population). The dose-response patterns were observed between the likelihood of incurring LA PED visit and either child's age (OR 1.06-1.35 as age groups increase, p<0.0001) or family socioeconomic status (OR 1.02-1.21 as family income levels decrease, p<0.05).
Conclusion:
Despite a comprehensive coverage of emergency care and low cost-sharing obligations under a single-payer universal health insurance programme in Taiwan, no significant increase in PED utilisation for LA conditions was observed between 2000 and 2015. Taiwan's experience may serve as an important reference for countries considering healthcare system reforms.
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