Chao-Chin Sherina Lee Jui-fen Rachel Lu Chang Gung University, Taiwan ihea July 11-July 13, 2011
Motivation Children is the future hope of a country With a declining total fertility rate (TFR) in Taiwan, issue of children health become even more important With NHI coverage, we are interested in studying health equality and equity in health care by children Children are dependents 2
Study aims T To further explore the factors influencing the distribution 3
Introduction 4
Introduction Impacts on children s health and health care use Main care givers Parents Family background and income Health insurance Government medical scheme subsidy policy 5
Method: Data Multistage stratified systematic sampling design Probability proportional to size (PPS) on each strata. Western doctor, dentist, prevention care, licensed traditional medicine practitioner (LTMP), emergency room visits, inpatient admission, 6
Use concentration index (C) as the measure of relative income-related inequality in use of health care (Wagstaff et al, 1991). Estimates for C and its robust standard error are obtained by running the following convenient regression (Kakwani, Wagstaff et al, 1997): where is the variance of R i and β is equal to C
Linear OLS to explain y, total health care utilization rates (plus standard 2-part outcomes as well): Income (lninc) Health need standardizing variables (x) Age, sex and self-assessed health Non-need variables (z) Main care giver s characteristics - including age, sex, education, economic activity status/occupation Geographic region Supply-side - including Herfindahl-Hirschman Index (HHI), health care facilities per 10,000 pop, physicians per 1,000 pop
Estimated (partial) demand elasticity of each determinant k was defined as: The total concentration index can be written as: where the first term denotes the partial contribution of income inequality, the second the contribution of health need variables, the third the contribution of all other variables and the last term is the generalized concentration index of ε
By indirect standardization, compute an index of horizontal inequity (HI) in health care use by subtracting the need-expected inequality from total inequality: HI=[-2, 2]
Sample characteristics of sampled children in 2001 in Taiwan (N=3,470) Variables No. of obs. % Child Household income per equivalent adult per month NTD 10,000 and below 612 17.64% NTD 10,001-20,000 1,177 33.92% NTD 20,001-30,000 828 23.86% NTD 30,001-40,000 342 9.86% NTD 40,001-50,000 295 8.50% NTD 50,001-60,000 139 4.01% NTD 60,001-70,000 29 0.84% NTD 70,001-80,000 11 0.32% NTD 80,001 and above 37 1.07% Self-assess health Good 2516 72.51% Common 858 27.73% Bad 96 2.77% Diseases Learning disability 44 1.27% developmental delay 47 1.36% Major care giver Education Informal education 56 1.61% Elementary school 318 9.16% Senior high 797 22.97% High 1594 45.94% University and above 705 20.32% Activity status Employed 2118 61.04% Non-employed 1352 38.96% 12
Inequality indices for health Learning disability Pro-poor distribution HI: -0.1701 Developmental delay Pro-poor distribution HI: -0.1931 13
Inequality indices for volume of utilization 14
Decomposition of inequality in volume of utilization 15
Discussion & Conclusion Compared to the study by Lu et. al (2007) on adults health care utilization that number of visits consumed by children is more than that by adults. Children are not as mature as adults. Subject to unexpected diseases. Socioeconomic characteristics of the care givers matter for children health and use of care Pro-rich tendency in health care Western doctor, dentist, Chinese doctor and emergency room Pro-poor distribution in d learning disability and development delay 17
Discussion & Conclusion Future policy directs M E 18
Acknowledgements This study was funded by: International Development Research Centre, Canada (IDRC Grant Number 105231) AusAID (Australian Development Research Award Grant Number 44741) Asian Development Bank (ADB RETA-6515) Analysis for Taiwan was funded by Taiwan National Science Council (NSC96-2416-H-182-001-MY3) 19
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