Is there a disparity in the hospital care received under a universal health insurance program in taiwan?

Abstract

Objective. To analyze the disparity in hospital care among people of various socio-economic status (SES) under a universal health insurance scheme. Design. A survey questionnaire was mailed to discharged patients in October 2010. Setting. This study included 183 large-scale hospitals in Taiwan. Participants. A total of 3015 patients/caregivers completed the questionnaires, which yielded a response rate of 58%. Main Outcome Measures. Three variables were included. The two access-to-care variables were admission route and accreditation level of the hospital in which the patient stayed. A structured questionnaire, the patient-reported hospital quality (PRHQ), was included to characterize patient's experience of hospital stay. Results. Patients with lower education were less likely to be admitted to a hospital according to a planned schedule, or to choose an Medical Center Hospital. However, SES was not associated with the PRHQ scores. Furthermore, patients with unplanned admission were associated with lower PRHQ scores than those with planned admission to the hospital. Conclusions. Under the universal health insurance system in Taiwan, lower education is associated with unplanned admission to a hospital, which might result in poorer perceived quality of care. Reducing unplanned admission is a challenge for health authorities in the future. © The Author 2013. Published by Oxford University Press in association with the International Society for Quality in Health Care; All rights reserved.