Inequality of trauma care under a single-payer universal coverage system in Taiwan: A nationwide cohort study from the National Health Insurance Research Database

Ling Wei Kuo, Chih Yuan Fu, Chien An Liao, Chien Hung Liao, Chi Hsun Hsieh, Shang Yu Wang, Shao Wei Chen, Chi Tung Cheng*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

5 Scopus citations

Abstract

Objectives To assess the impact of lower socioeconomic status on the outcome of major torso trauma patients under the single-payer system by the National Health Insurance (NHI) in Taiwan. Design A nationwide, retrospective cohort study. Setting An observational study from the NHI Research Database (NHIRD), involving all the insurees in the NHI. Participants Patients with major torso trauma (injury severity score ≥16) from 2003 to 2013 in Taiwan were included. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to identify trauma patients. A total of 64 721 patients were initially identified in the NHIRD. After applying the exclusion criteria, 20 009 patients were included in our statistical analysis. Primary and secondary outcome measures The primary outcome measure was in-hospital mortality, and we analysed patients with different income levels and geographic regions. Multiple logistic regression was used to control for confounding variables. Results In univariate analysis, geographic disparities and low-income level were both risk factors for in-hospital mortality for patients with major torso trauma (p=0.002 and <0.001, respectively). However, in multivariate analysis, only a low-income level remained an independent risk factor for increased in-hospital mortality (p<0.001). Conclusion Even with the NHI, wealth inequity still led to different outcomes for major torso trauma in Taiwan. Health policies must focus on this vulnerable group to eliminate inequality in trauma care.

Original languageEnglish
Article numbere032062
JournalBMJ Open
Volume9
Issue number11
DOIs
StatePublished - 2019
Externally publishedYes

Bibliographical note

Publisher Copyright:
© © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords

  • National Health Insurance
  • Taiwan
  • inequality
  • relative poverty
  • trauma

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