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Copyright of Taiwan Journal of Publich Health / Taiwan Gong Gong Wei Sheng Za Zhi is the property of Taiwan Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The study investigated the characteristics of managed entry agreements (MEAs) in Taiwan by using open data. Methods: Data were derived from the official website of the National Health Insurance Administration (NHIA). The MEAs requested during the Pharmaceutical Benefit and Reimbursement Scheme Joint committee (PBRS) meeting to be signed between NHIA and the industry were investigated. Results: Between October 2018 and October 2021, 77 MEAs were requested, 12 of which have not been concluded. Among the signed MEAs, three were agreed to be terminated, and re-discussion was requested for two. Among the required agreements, 63 (82%) were finance-based MEAs, 4 (5%) were performance-based MEAs, and 10 (13%) were unspecified. An analysis of the therapeutic areas of the drugs listed in the MEAs by using the Anatomical Therapeutic Chemical (ATC) classification system revealed that most drugs were antineoplastic and immunomodulating drugs (ATC-L, approximately 73%), followed by anti-infectives for systemic use (ATC-J, approximately 12%). Conclusions: The focus of payers on drug reimbursement varies from country to country; in the local PBRS meeting, focus was identified as the main issue relating to drug budget impact. MEAs allow the NHIA to discuss with the pharmaceutical companies regarding a confidential discount or payment cap of a treatment course to facilitate patient access to new drugs while managing the healthcare expenditure. [ABSTRACT FROM AUTHOR]

Objectives: The mortality and readmission rates of patients with stroke after discharge are high, and the associated medical costs are high. Patients receiving fragmented care after discharge have an increased hospitalization rate and higher medical expenses than other patients. Studies have indicated that the better is the continuity of care among patients with stroke, the lower is their mortality rate after discharge. However, the relationship between the continuity of care and hospitalizations and medical expenses is unclear. This study explored the associations of the continuity of postdischarge care with healthcare outcomes and expenses among patients with ischemic stroke. Methods: Patients hospitalized for ischemic stroke were included in a nationally representative sample using data from the Health and Welfare Data Science Center, Ministry of Health and Welfare. The continuity of care index (COCI) was calculated using outpatient data after discharge. The patients were divided into low, medium, and high COCI groups. Logistic regression, negative binomial regression, and gamma regression were used to explore the associations of care continuity with mortality, hospitalizations, and medical expenses. Results: A total of 2,447 patients were included. High continuity of care was related to low mortality, low hospitalizations, and low medical expenses. Conclusions: High continuity of care among patients with ischemic stroke is associated with a reduction in hospitalizations and a low risk of death. Therefore, healthcare authorities can increase the continuity of care to improve patient outcomes and reduce medical expenses. [ABSTRACT FROM AUTHOR]

Copyright of Taiwan Journal of Publich Health / Taiwan Gong Gong Wei Sheng Za Zhi is the property of Taiwan Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Taiwan Journal of Publich Health / Taiwan Gong Gong Wei Sheng Za Zhi is the property of Taiwan Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To improve prenatal care utilization and birth outcomes, prenatal care coordination for pregnant women is internationally regarded as a critical strategy. Since 2017, a care coordination pilot program for high-risk (socioeconomic- and pregnancy-related risks) pregnant women has been implemented in Taiwan. The objective of this study was to examine the preliminary impact of this program on prenatal care utilization and birth outcomes among high-risk pregnant women. Methods: Data provided by the Health Promotion Administration on all women who gave birth at any time between May 2017 and May 2018 were employed. Propensity score matching and multivariate binary logistic regression were performed to examine whether the program intervention reduced the odds of having fewer than 4 or 8 prenatal care visits, a caesarean section, a baby with low birth weight, a preterm baby, or obstetric complications. Results: Each group included 621 pregnant women after matching. Pregnant women who participated in the program had lower odds of having fewer than 4 prenatal visits or a baby with low birth weight compared with those who did not participate (odds ratio: 0.11, 95% confidence interval: 0.03– 0.44; odds ratio: 0.42, 95% confidence interval: 0.23–0.77). Conclusions: The preliminary impact of the care coordination pilot program is, first, an increase in the proportion of high-risk pregnant women who undergo at least 4 prenatal care visits and, second, a decrease in the proportion of babies with low birth weight in this group. [ABSTRACT FROM AUTHOR]

Copyright of Taiwan Journal of Publich Health / Taiwan Gong Gong Wei Sheng Za Zhi is the property of Taiwan Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Since 2009, the Taiwanese government has subsidized treatment for non-AIDSrelated drug addiction. The aim of this retrospective cohort study was to investigate the effect on National Health Insurance (NHI) resources of treatment for people with addiction who enrolled in a methadone substitution treatment program. Methods: Data from 2009 to 2014 of people with drug addiction who were treated with methadone were collected as samples. Analytical tools such as the Inverse Probability of Treatment Weighting (IPTW), which is based on propensity score and weighted multiple regression, were used to further compare the use of NHI resources by the stable-treatment and interrupted-treatment groups. Individual characteristics of sex, age, and income level were controlled for in addition to the level, ownership, and Bureau of NHI branch of the medical institution. Results: According to the weighted multiple regression analysis results of the NHI point values of the outpatient and emergency departments, the NHI point values of the stable-treatment group increased by 9% relative to the interrupted-treatment group (p = 0.0023). The results of a Poisson regression on the NHI utilization frequency of outpatient and emergency department visits indicated that with the same control variables, the average NHI utilization frequency of the stable-treatment group increased by 14% relative to the interruptedtreatment group (p < 0.001). Conclusions: Among people with addiction who enrolled in the methadone substitution treatment program, those in the stable-treatment group had not only higher logarithmic NHI point values but also higher NHI utilization frequency in their outpatient and emergency department visits compared with the interrupted-treatment group. Although no statistical significance was observed, further research should investigate why, after IPTW, the average annual inpatient point values for the interrupted-treatment group were higher than those for their stable-treatment counterparts. [ABSTRACT FROM AUTHOR]

Objectives: Gestational diabetes mellitus (GDM) is associated with type 2 diabetes mellitus and adverse outcomes for both mothers and infants. Screening is a valuable method for identifying women at risk for GDM, and universal screening along with targeted screening is a key strategy for such identification. However, consensus is lacking regarding which GDM screening strategy is appropriate for pregnant women. Hence, the objective of this study was to compare the costeffectiveness of GDM screening strategies from the third payer perspective. Methods: A decision tree model was used to assess the costs and quality-adjusted life years (QALYs) for three GDM screening strategies: universal screening, targeted screening, and no screening. The Taiwan National Health Insurance Research Database and a literature review were used to estimate the model parameters. Sensitivity analysis was performed to evaluate the robustness of assessment. Results: Compared with the no screening strategy, universal screening and targeted screening were cost-effective. Universal screening was a cost-effective approach for decreasing the risks of GDM complications compared with targeted screening or no screening. Relative to targeted screening, universal screening generated an incremental cost-effectiveness ratio of $928/QALY gained. Sensitivity analysis provided similar results. Conclusions: Universal screening is a costeffective approach for improving maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Taiwan Journal of Publich Health / Taiwan Gong Gong Wei Sheng Za Zhi is the property of Taiwan Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study explored the characteristics of hospitals’ systems for malpractice dispute management. Suggestions are proposed for improving hospitals’ policies in this field. Methods: Eighteen physicians who had experienced malpractice disputes in the past 10 years were interviewed. Results: Most physicians received legal and financial support from hospital systems for malpractice disputes, but emotional support from colleagues and supervisors was inadequate due to a prevalent culture of shame and liability in malpractice dispute contexts. Hospital systems were reported to examine dispute events to assure monetary compensation but not to discover root causes of events or to devise preventive strategies. Most hospitals were determined to be reactive, with few implementing policies to proactively prevent malpractice disputes. Conclusions: Government authorities handling health affairs should request that hospitals organize educational activities regularly to improve medical staff members’ knowledge and attitudes regarding malpractice disputes. Each malpractice dispute requires root cause analysis and recording of results to guide future policies. For resolution of potential malpractice disputes, hospitals should implement preventive policies to enable early assistance when adverse outcomes or patient complaints occur. [ABSTRACT FROM AUTHOR]

Objectives: Accountability for reasonableness (A4R) provides a coherent theoretical framework to evaluate healthcare distributive justice as part of healthcare policy. This study aimed to analyze people’s knowledge about and attitudes toward employing A4R (including relevance of decisions, transparency, involvement of stakeholders, and revisability) in the National Health Insurance (NHI) treatment/drug reimbursement decision-making process, and to explore factors associated with the relevance of such decisions. Methods: A total of 1,140 adults aged 20 and over were randomly sampled from a nationwide population and interviewed by telephone. Multinomial logistic regression was used to examine the associations of individual characteristics, transparency, involvement of stakeholders, and revisability with the relevance of decisions. Results: Most respondents regarded A4R as essential to the NHI reimbursement decision-making process, but only few recognized how A4R was implemented. Additionally, with regard to considerations about setting healthcare priorities - (medical efficacy, disease burden, treatment/drug price), respondents’ concerns about price were associated with age, education, income, medical utilization, and their subjective perspectives about transparency and the involvement of stakeholders. Their concerns about disease burden were associated with age, income, chronic disease status, and subjective perspective about the involvement of stakeholders. Conclusions: Even though most people agree on employing A4R to support fair priority-setting in NHI’s reimbursement decision-making, a gap exists between their attitudes and knowledge. Additionally, public attitudes about the relevance of decisions are associated with socio-economic characteristics and concerns about transparency and the involvement of stakeholders. [ABSTRACT FROM AUTHOR]

Objectives: Previous research has shown that discharged patients following acute myocardial infarction (AMI) who had higher continuity of pre-admission care had better post-discharge care outcomes; however, no study has determined whether or not discharged patients following AMI who had higher continuity of post-discharge care had better post-discharge care outcomes. Moreover, no study has determined the relative strength of influence of pre-admission and post-discharge care continuity on post-discharge outcomes and expenses. Methods: This study utilized data from the nationwide representative sample through the National Health Insurance Research Database, and analyzed 1,884 AMI patients discharged from the hospital between 2007 and 2011. Generalized estimating equation and Cox proportional hazard models with robust sandwich variance estimates were performed to examine the effects of pre-admission and post-discharge care continuity on 1-year post-discharge mortality, readmissions, and medical expenses. Results: There was no significant relationship of continuity of pre-admission care to post-discharge care outcomes and medical expenses. Patients with a high continuity of post-discharge care had lower 1-year post-discharge mortality, readmissions, and medical expenses. Conclusions: Among AMI patients, post-discharge care continuity, rather than pre-admission care continuity, is associated with post-discharge care outcomes and medical expenses. Therefore, to improve post-discharge care outcomes and medical expenses, health policy makers and providers might focus on enhancing continuity of post-discharge care for patients with AMI. [ABSTRACT FROM AUTHOR]

Copyright of Taiwan Journal of Publich Health / Taiwan Gong Gong Wei Sheng Za Zhi is the property of Taiwan Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Taiwan Journal of Publich Health / Taiwan Gong Gong Wei Sheng Za Zhi is the property of Taiwan Public Health Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)