Digital Health Care in Taiwan

This open access book introduces the National Health Insurance (NHI) system of Taiwan with a particular emphasis on its application of digital technology to improve healthcare access and quality. The authors explicate how Taiwan integrates its strong Information and Communications Technology (ICT) industry with 5G to construct an information system that facilitates medical information exchange, collects data for planning and research, refines medical claims review procedures and even assists in fighting COVID-19. Taiwan's NHI, launched in 1995, is a single-payer system funded primarily through payroll-based premiums. It covers all citizens and foreign residents with the same comprehensive benefits without the long waiting times seen in other single-payer systems. Though premium rate adjustment and various reforms were carried out in 2010, the NHI finds itself at a crossroads over its financial stability. With the advancement of technologies and an aging population, it faces challenges of expanding coverage to newly developed treatments and diagnosis methods and applying the latest innovations to deliver telemedicine and more patient-centered services. The NHI, like the national health systems of other countries, also needs to address the privacy concerns of the personal health data it collects and the issues regarding opening this data for research or commercial use. In this book, the 12 chapters cover the history, characteristics, current status, innovations and future reform plans of the NHI in the digital era. Topics explored include: Income Strategy Payment Structure Pursuing Health Equity Infrastructure of the Medical Information System Innovative Applications of the Medical Information Applications of Big Data and Artificial Intelligence Digital Health Care in Taiwan is essential reading for academic researchers and students in healthcare administration, health policy, health systems research, and health services delivery, as well as policymakers and public officials in relevant government departments. It also would appeal to academics, practitioners, and other professionals in public health, health sciences, social welfare, and health and biotechnology law

Digital Health Care in Taiwan

This open access book introduces the National Health Insurance (NHI) system of Taiwan with a particular emphasis on its application of digital technology to improve healthcare access and quality. The authors explicate how Taiwan integrates its strong Information and Communications Technology (ICT) industry with 5G to construct an information system that facilitates medical information exchange, collects data for planning and research, refines medical claims review procedures and even assists in fighting COVID-19. Taiwan's NHI, launched in 1995, is a single-payer system funded primarily through payroll-based premiums. It covers all citizens and foreign residents with the same comprehensive benefits without the long waiting times seen in other single-payer systems. Though premium rate adjustment and various reforms were carried out in 2010, the NHI finds itself at a crossroads over its financial stability. With the advancement of technologies and an aging population, it faces challenges of expanding coverage to newly developed treatments and diagnosis methods and applying the latest innovations to deliver telemedicine and more patient-centered services. The NHI, like the national health systems of other countries, also needs to address the privacy concerns of the personal health data it collects and the issues regarding opening this data for research or commercial use. In this book, the 12 chapters cover the history, characteristics, current status, innovations and future reform plans of the NHI in the digital era. Topics explored include: Income Strategy Payment Structure Pursuing Health Equity Infrastructure of the Medical Information System Innovative Applications of the Medical Information Applications of Big Data and Artificial Intelligence Digital Health Care in Taiwan is essential reading for academic researchers and students in healthcare administration, health policy, health systems research, and health services delivery, as well as policymakers and public officials in relevant government departments. It also would appeal to academics, practitioners, and other professionals in public health, health sciences, social welfare, and health and biotechnology law

THE RELATIONSHIP BETWEEN AMBULATORY CARE LAPSES AND MEDICAL UTILIZATION IN DIABETIC PATIENTS

It remains unclear whether lapses in ambulatory care for diabetic patients influences the subsequence medical utilization. Therefore, the objective of this study was to clarify whether different duration of ambulatory care lapses were associated with the stroke utilization in diabetic patients with subsequence ischemic stroke. We conducted a retrospective cohort study by using Taiwanese National Health Insurance Research Database. Study population were diabetic patients aged 20 and over with subsequence ischemic stroke. According to lapses between the last diabetic ambulatory care and the ischemic stroke, patients were classified into five groups(from group A to group E), which were lapse A) within 90 days, B) within 91 to 180 days, C) within 181 to 270 days, D) within 271 to 365 days, and E) over 365 days. The interests outcomes were stroke hospitalization expenditure, length of stay, and stroke severity. Groups were compared on characteristics at the ischemic stroke, the use of diabetic care and stroke utilization by using analysis of variance test for continuous variables and chi-square test for categorical variables, as appropriate. The multivariate regression models and multinomial logistic regression model was used to estimate the association between different duration of ambulatory care lapses and interested outcomes. A total of 76,194 diabetic patients with subsequence ischemic stroke during 2002 to 2012 were included for analysis. Average hospitalization cost per day was 1.03% higher for patients in group E when compared to patients in group A. Patients in group B, group D, and group E, comparing to group A, had statistically significant longer length of stay for stroke, which were 0.79, 1.05 and 0.65 days, respectively. Stroke severity was higher associated with diabetic patients in group B, group D, and group E when compared to patients in group A. In conclusion, this study found that diabetic patients with subsequence ischemic stroke having the last ambulatory care over 365 days tend to have higher severity, higher hospitalization cost per day, and longer length of stay for ischemic stroke. Therefore, this study suggests to enhance better monitoring and better management for all diabetic patients especially for those patients with longer lapses

The Role of Professional Identity into Explaining Saudi Arabian Healthcare Professional Resistance to Electronic Health Records’ Stratigic Change in Public Hospitals

Electronic Health Record (EHR) is an application that captures patients’ information and promises to improve healthcare services. Hence, many countries, including the developing country, such as Saudi Arabia, invested heavily to implement the system and improve healthcare service delivery. Yet, the system's adoption is slow, and failure is high, which could be related to healthcare professionals’ resistance to change to the EHR applications. Further, despite the importance of the topic of EHR resistance, little research has been conducted in Saudi Arabia regarding healthcare professionals’ resistance to change to EHR. Motivated thus, this research suggested that resistance to EHR in Saudi Arabia results from cultural and professional identity factors, which guide healthcare professionals’ behaviour. Therefore, this research investigated how the professional identity of Saudi healthcare professionals can explain their resistance tousing EHR applications. The study used identity theory as our main theoretical lens along with Hofstede cultural dimension theory and in-depth qualitative interviews to understand the EHR resistance to change phenomenon. Our study has revealed similarities between Saudi and Western healthcare professionals’ factors that could contribute to EHR resistance. However, interestingly, cultural, and religious norms were also found to be one of the leading causes of Saudi healthcare professionals’ resistance to the EHR change. Our theoretical contributions helped us understand the role of identity in EHR use in a place where professionals with a strong professional and cultural identity are the system's main users. In addition, our practical contributions aimed to help the Ministry of Health in Saudi Arabia to understand what healthcare professional needs before adapting an EHR system, or improve the current once. Further, it could help hospital managers address, understand, and solve the challenges facing healthcare professionals as they use the EHR system