Cultural Issues in Using the SF-36 Health Survey in Asia: Results from Taiwan

BACKGROUND: The feasibility of using the SF-36 in non-Western cultures is important for researchers seeking to understand cultural influences upon health status perceptions. This paper reports on the performance of the Taiwan version of the SF-36, including the implications of cultural influences. METHODS: A total of 1191 volunteered subjects from the general population answered the translated SF-36 Taiwan version, which was developed following IQOLA project protocols. RESULTS: Results from tests of scaling assumptions and reliability generally were satisfactory. Convergent validity, as assessed by comparing the SF-36 to a mental health oriented inventory, was acceptable. Results of principal components analysis were similar to US results for many scales. However, differences were seen for the Vitality scale which was a stronger measure of mental health than physical health in Taiwan. Results are compared to those from other Asian studies and the U.S. CONCLUSION: The results raise important questions regarding cultural influences in international studies of health status assessment. Further research into the conceptualization and components of mental health in Asian countries is warranted

Evolution of Taiwan's Health Care System

This study aims to present an overview of the evolutionary policy process in reforming the health care system in Taiwan , through dissecting the forces of knowledge, social- cultural context, economic resources and political system. We further identify factors, which had a significant impact on health care reform policies in Taiwan through illustrative policy examples. One of the most illuminating examples highlighted is the design and implementation of a single-payer National Health Insurance (NHI ) program in 1995 , after nearly five years of planning efforts (1988-1993 ) and a two-year legislative marathon. The NHI is one of the most popular social programs ever undertaken in the history of Taiwan, which greatly enhances financial protection against unexpected medical expenses and assures access to health services. Nonetheless, health care reform still has an unfinished agenda. Despite high satisfaction ratings, Taiwan's health care system today is encountering mounting pressure for new reforms as a result of its rapidly aging population, economic stagnation, and imbalanced NHI checkbook. Although there may exist some heterogeneous system characteristics and challenges among different health care systems around the world, Taiwan's experiences in reforming its health care system for the past few decades may provide valuable lessons for countries going through rapid economic and political transition

Building a hospital alliance taiwan landseed medical alliance

Following the launch of the National Health Insurance (NHI) program in 1995, universal coverage was achieved in Taiwan. In the period immediately following the introduction of the program, private hospitals did well and many opportunists entered Taiwan's rapidly expanding, prosperous healthcare market. However, the boom did not last long, ending with Bureau of NHI's hospital global budget system in 2002. The new NHI policies, stricter regulations, and higher public expectations of healthcare services intensified competition in the healthcare market and many private hospitals were forced to close. The Taiwan Landseed Medical Alliance (TLMA) was formed in 1993 by eight hospitals. It was the first successful hospital alliance in Taiwan. Although most of the alliance members were private district hospitals, through collaboration and integrated networks TLMA offered a unique model that combined the strength of each of these small-scale hospitals. The alliance thus enhanced the ability of its members to survive despite fierce competition, and increased their capacity to provide first-rate health care. By fully implementing the operations and development strategies inherent in a collaborative hospital group, TLMA members worked through difficulties together and are already on course to meet many other alliance goals including the upgrading of hospital management practices and service quality, improvement of the medical environment, and promotion of good hospital practice. The case aims to evoke discussion on the important role of alliances in competitive markets and ways to form strategic alliances. Supportive actions and alliance structures should also be considered. [ABSTRACT FROM AUTHOR] Copyright of Asian Case Research Journal is the property of World Scientific Publishing Company 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

Building a Hospital Alliance — Taiwan Landseed Medical Alliance

Following the launch of the National Health Insurance (NHI) program in 1995, universal coverage was achieved in Taiwan. In the period immediately following the introduction of the program, private hospitals did well and many opportunists entered Taiwan's rapidly expanding, prosperous healthcare market. However, the boom did not last long, ending with Bureau of NHI's hospital global budget system in 2002. The new NHI policies, stricter regulations, and higher public expectations of healthcare services intensified competition in the healthcare market and many private hospitals were forced to close.The Taiwan Landseed Medical Alliance (TLMA) was formed in 1993 by eight hospitals. It was the first successful hospital alliance in Taiwan. Although most of the alliance members were private district hospitals, through collaboration and integrated networks TLMA offered a unique model that combined the strength of each of these small-scale hospitals. The alliance thus enhanced the ability of its members to survive despite fierce competition, and increased their capacity to provide first-rate health care. By fully implementing the operations and development strategies inherent in a collaborative hospital group, TLMA members worked through difficulties together and are already on course to meet many other alliance goals including the upgrading of hospital management practices and service quality, improvement of the medical environment, and promotion of good hospital practice.The case aims to evoke discussion on the important role of alliances in competitive markets and ways to form strategic alliances. Supportive actions and alliance structures should also be considered.

Evaluation of Medical Outcomes Study Short Form-36 Taiwan version in assessing elderly patients with hip fracture

The Medical Outcomes Study Short Form-36 (SF-36) is a widely used measure of generic health related quality of life. The purpose of this study is to establish the validity and reliability of the SF-36, Taiwan Version, when applied to a sample of elderly patients with hip fracture in Taiwan. Data from two samples were used, the first sample ( n =87) from a prospective descriptive study for testing psychometric scaling assumptions, scale responsiveness and criterion validity, and the second sample ( n =69) from a clinical trial for examining the validity of the differences in the group. The SF-36 Taiwan version demonstrated good evidence of supporting the scaling assumption. Cronbach’s alpha coefficients above 0.70 for all scales support the internal consistency. The Physical Function (PF) scale had an effect size of 0.88 from months 1 to 3, and 0.59 from months 3 to 6 after discharge, which appears to have the best responsiveness to clinical changes. Notable floor and ceiling effects (>15%) for Role Emotion (RE), Role-Physical (RP) and PF scales were found. High correlation of 0.62 between the PF and measures of activities of daily living (ADLs), and between RP and instrumental activities of daily living (IADLs) (0.63) supports the construct validity. Significantly higher performance in most SF-36 scales in elders without risk for depression than those who were at risk supported the validity of the group differences. In its current form, the SF-36 Taiwan version demonstrated good reliability and validity as applied to patients with hip fracture.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45910/1/198_2003_Article_1580.pd

Changes in quality of life among elderly patients with hip fracture in Taiwan

To examine the longitudinal change in health related quality of life (HRQoL) during 1 year following hospital discharge in elderly subjects, 110 hip fractured subjects (age, mean±SD: 79.3±7.4 years) were enrolled in a prospective study. Face-to-face interviews with the patients were conducted, using Short Form 36 (SF-36) at 1, 3, 6, and 12 months after they were discharged from the hospital. The GEE approach was employed to evaluate changes in the variables of interest among different time points. Subjects in this study appeared to have lower scores in most dimensions of SF-36, with physical function and role limitation being the lowest due to physical problems (mean±SD=10.97±16.19; 6.32±20.60) during the 1st month after hospital discharge, compared to community dwelling subjects (mean±SD=77.5±20.5; 63.8±45.30). Most of the dimensions of SF-36, except general health (6th month versus 3rd month=57.56±21.90 versus 61.75±23.46, P >0.05) improved significantly from the 1st month to the 3rd month (range of means of improved scores from 12.81 to 30.76, P <0.01). After the 3rd month after discharge, physical functions kept improving significantly until 6 months after hospital discharge (3rd month versus 6th month=25.18±23.66 versus 40.30±25.94, P <0.05). Role limitation due to physical problems reached a plateau between the 3rd and 6th month, and then again improved significantly during the 6th month and the 1st year after hospital discharge (6th month versus 1st year=17.69±31.78 versus 32.22±44.47, P <0.05). The rest of the dimensions of SF-36 remained stable from the 3rd month to 1 year after discharge. These results indicated that different aspects of SF-36 recovered differently for the hip fractured patients in Taiwan. Similar studies may be helpful for health-care providers in other countries with Chinese populations to develop specific intervention programs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45907/1/198_2003_Article_1533.pd

Are quality-adjusted medical prices declining for chronic disease? Evidence from diabetes care in four health systems.

Improvements in medical treatment have contributed to rising health spending. Yet there is relatively little evidence on whether the spending increase is "worth it" in the sense of producing better health outcomes of commensurate value-a critical question for understanding productivity in the health sector and, as that sector grows, for deriving an accurate quality-adjusted price index for an entire economy. We analyze individual-level panel data on medical spending and health outcomes for 123,548 patients with type 2 diabetes in four health systems: Japan, The Netherlands, Hong Kong and Taiwan. Using a "cost-of-living" method that measures value based on improved survival, we find a positive net value of diabetes care: the value of improved survival outweighs the added costs of care in each of the four health systems. This finding is robust to accounting for selective survival, end-of-life spending, and a range of values for a life-year or fraction of benefits attributable to medical care. Since the estimates do not include the value from improved quality of life, they are conservative. We, therefore, conclude that the increase in medical spending for management of diabetes is offset by an increase in quality.Public Health and primary car

Who pays for health care in Asia?

We estimate the distributional incidence of health care financing in 13 Asian territories that account for 55% of the Asian population. In all territories, higher-income households contribute more to the financing of health care. The better-off contribute more as a proportion of ability to pay in most low- and lower-middle-income territories. Health care financing is slightly regressive in three high-income economies with universal social insurance. Direct taxation is the most progressive source of finance and is most so in poorer economies. In universal systems, social insurance is proportional to regressive. In high-income economies, the out-of-pocket (OOP) payments are proportional or regressive while in low-income economies the better-off spend relatively more OOP. But in most low-/middle-income countries, the better-off not only pay more, they also get more health care.