The objective of this study is to estimate the amount of and factors associated with out-of-pocket (OOP) payment for medical care under Taiwan's National Health Insurance (NHI) program. This research used two methods to collect... more
The objective of this study is to estimate the amount of and factors associated with out-of-pocket (OOP) payment for medical care under Taiwan's National Health Insurance (NHI) program. This research used two methods to collect original data. The first method consisted of using a sample household survey and household diary records to collect data on OOP payment prospectively over a two-month period from a random sample of 600 households in central Taiwan. Using the individual as the unit of analysis, we obtained a total of 1062 sample subjects. To ascertain the quality and accuracy of survey data, the claim records of the bureau of NHI were merged with the survey data. These data were analyzed by a two-part model, with a probit model for use of health care and an ordinary least-squares model for OOP payments. Results of this research indicate that on average an individual's annual OOP payment for medical care was euro 247, which is substantial, compared with the average euro...
In this study, we utilized the nested multinomial logit model to estimate the Willingness To Pay (WTP) values for different National Health Insurance (NHI) coverage plans in Taiwan. The WTP value for having care from clinics in a Hospital... more
In this study, we utilized the nested multinomial logit model to estimate the Willingness To Pay (WTP) values for different National Health Insurance (NHI) coverage plans in Taiwan. The WTP value for having care from clinics in a Hospital Care Only (HCO) plan is NT$178 (US$6) per person/month. The WTP value for having care from hospitals in a Clinic Care
The purpose of this article is to investigate one core research question: How can health information technology (HIT) be assessed in a national health care system context? We examine this question by taking a systematic approach within a... more
The purpose of this article is to investigate one core research question: How can health information technology (HIT) be assessed in a national health care system context? We examine this question by taking a systematic approach within a national care system, in which the purpose of HIT is to contribute to a common national health care system's goal. to promote population health in an efficient way. Based on this approach we first develop a framework and our criteria of assessment, and then using Taiwan as a case study, demonstrate how one can apply this framework to assess a national system's HIT. The five criteria we developed are how well does the HIT (1) provide accessible and accurate public health and health care information to the population; (2) collect and provide population health and health care data for government and researchers to analyze population health and processes and outcomes of health care services, (3) provide accessible and timely information that hel...
This article aims to explore three main concepts related to the professional development of nursing professionals. This paper first critically reviews and reinterprets scientific evidence on the relationship between nurse staff allocation... more
This article aims to explore three main concepts related to the professional development of nursing professionals. This paper first critically reviews and reinterprets scientific evidence on the relationship between nurse staff allocation and healthcare outcomes and then challenges some of the common interpretations of this evidence in the professional literature. Secondly, in the absence of solid empirical evidence provided by sophisticated datasets in this field, we consider how Communitarianism may provide a well-defined, highly appropriate ethical framework for further developing and improving the nursing profession and healthcare outcomes. Thirdly, this article examines the role of Communitarian ethics in setting Taiwan's healthcare priorities and promotion nursing's core professional values. In conclusion, we recommend several conceptual health policy frameworks to ensure patient safety.
Striking changes in the funding and implementation of international health programs in recent decades have stimulated debate about the role of communities in deciding which health programs to implement. An important yet neglected piece of... more
Striking changes in the funding and implementation of international health programs in recent decades have stimulated debate about the role of communities in deciding which health programs to implement. An important yet neglected piece of that discussion is the need to change norms in program evaluation so that analysis of community ownership, beyond various degrees of "participation," is seen as central to strong evaluation practices. This article challenges mainstream evaluation practices and proposes a framework of Critical Evaluation with 3 levels: upstream evaluation assessing the "who" and "how" of programming decisions; midstream evaluation focusing on the "who" and "how" of selecting program objectives; and downstream evaluation, the focus of current mainstream evaluation, which assesses whether the program achieved its stated objectives. A vital tenet of our framework is that a community possesses the right to determine the ...
Rationale: During the last two decades, we observed the acceleration of economic globalization throughout most part of the world. Nations that intensified their economic globalization, however, experienced different impacts on their... more
Rationale: During the last two decades, we observed the acceleration of economic globalization throughout most part of the world. Nations that intensified their economic globalization, however, experienced different impacts on their health development. While some nations' health development benefited from their economic globalization, others suffered. Objectives: The objective of this study is first to operationalize the concept of economic globalization, and to examine the relationship between economic globalization and health development over the last two decades among middle-income and low-income nations. Research Method: This study first conceptualizes the concept "economic globalization" as a nation's involvement in international trade, foreign investment in the nation, its receipts of official development assistance, international economic regime's intervention of a nation's economic policies, and its external debts. Time series data on these variable...
This study investigated teachers' perceptions of their role as HIV/AIDS educators and also their role in providing care for orphans and vulnerable children (OVC) across the different school systems in Lusaka, Zambia. Researchers used... more
This study investigated teachers' perceptions of their role as HIV/AIDS educators and also their role in providing care for orphans and vulnerable children (OVC) across the different school systems in Lusaka, Zambia. Researchers used a combined quantitative and qualitative narrative approach. Original cross-sectional data were collected through face-to-face survey and in-depth interviews with school teachers in the Lusaka. A sample of 720 teachers from 123 schools completed surveys in 2008, with a 91% response rate for teachers, and 100% for schools sampled. Teachers for all school types reported that schools and teachers are the appropriate community resource for HIV-prevention education for youth and support for OVC. This study suggests that schools could serve as a source and alternative mechanism of support for vulnerable children.
Page 1. AN ABSTRACT OF THE DISSERTATION OF Alana D. Knudson-Buresh for the degree of Doctor of Philosophy in Public Health presented on June 10, 1997. ... Page 3. Copyright by Alana D. Knudson-Buresh June 10, 1997 All Rights Reserved Page... more
Page 1. AN ABSTRACT OF THE DISSERTATION OF Alana D. Knudson-Buresh for the degree of Doctor of Philosophy in Public Health presented on June 10, 1997. ... Page 3. Copyright by Alana D. Knudson-Buresh June 10, 1997 All Rights Reserved Page 4. ...
The purpose of this study was to examine the relationship between adoption of case payment for laparoscopic cholecystectomy (LC) and the growth rate of LC, outcomes of patients undergoing LC, and total healthcare expenditures on... more
The purpose of this study was to examine the relationship between adoption of case payment for laparoscopic cholecystectomy (LC) and the growth rate of LC, outcomes of patients undergoing LC, and total healthcare expenditures on cholecystectomy. We used the claims data from Bureau of National Health Insurance (BNHI) to identify patients who underwent LC and open cholecystectomy (OC). Data were available from January 1996 to October 1997 and from January 1998 to October 1999, enabling use to compare data from before and after the introduction of the new case payment system. Results showed that the volume and the proportion of LCs increased after adoption of the new payment method. We did not find a sharp increase in the cholecystectomy rate during the study period. In terms of outcomes, the admission rate for emergencies decreased; the surgery mortality rate decreased, but the readmission rate increased. The average cost and length of hospital stay for LC subjects decreased; however, the total cost of cholecystectomy increased. The impact on LC of the introduction of a case payment method failed to reduce total health expenditures for cholecystectomy.
The purpose of this article is to first conceptualize health services utilization behavior as event counts. Based on this concept and behavioral theory, the author presents the Generalized Event Count model as an alternative modeling tool... more
The purpose of this article is to first conceptualize health services utilization behavior as event counts. Based on this concept and behavioral theory, the author presents the Generalized Event Count model as an alternative modeling tool for studying health services utilization. This model is theory driven and is consistent with behavioral assumptions. In presenting the Generalized Event Count model, the author first examines its model assumptions to see whether they conform to elements of behavior theory, assumptions of health services utilization, and the distribution assumption of the nature of the data. To demonstrate the Generalized Event Count model, the author applied this model to an empirical ambulatory care utilization data set from a 1988 household interview of Chinese-Americans in Boston's inner-city community. The Generalized Event Count model analysis suggested that the regular source of medical care and the use of Chinese medicine were strong predictors of physician visits for this population. Further, the Generalized Event Count model was able to test that most of the ambulatory visits within an individual were correlated. Compared with other models, the Generalized Event Count model is more consistent with health services utilization behavioral assumptions. Moreover, it makes an efficient use of information from the utilization data for model estimation. This model has the potential of having broad applications in studying various types of health services utilization, especially for analyzing cross-sectional utilization data.