Health equality and equity in health care utilization among children in Taiwan

Objectives: As children represent the future assets of a country, their access to care to maintain their health is critical. This study assessed the distribution of health and health care uses among children. The determinants of the equity distribution were also explored. Methods: The data were taken from the 2001 Taiwan National Health Interview Survey (NHIS) linked with the 2001 National Health Insurance Research Database (NHIRD); 3,470 children aged 12 and younger were identified as the sample. Income-related distribution of health and health care uses were examined by adapting the concentration index and the Index of Horizontal Inequity (HI). Decomposing the concentration index facilitated the identification of factors which contributed to the unequal and inequitable distribution of health and health care uses. Results: Children in poorer households were more likely to encounter developmental problems in hearing and learning. Visits to Western doctors (excluding visits for preventive services), dentists, and emergency rooms tended to show a pro-rich distribution; however, the rich and the poor showed similar patterns of hospital admissions. In general, the educational attainment of the main care giver and household income were the two major factors contributing to the observed inequity. Conclusions: More resources should be devoted to health promotion among care givers. Family characteristics of the socially disadvantaged should be considered when devising subsidy policies targeting children to effectively provide appropriate care to children in need. (Taiwan J Public Health. 2013;32(5):449-46I).