Assessing quality of primary diabetes care in South Korea and Taiwan using avoidable hospitalizations. Issue 11 (November 2018)

• Record Type: Journal Article
• Authors: Kim, Hongsoo; Cheng, Shou-Hsia
• Is Part Of: Health policy. Volume 122:Issue 11(2018)
• Page Start: 1222
• Page End: 1231
• Publication Date: 2018-11
• Subjects: Ambulatory care sensitive conditions -- Health system performance assessment -- Health policy -- Cross-national study -- Asia; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2018.09.009
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: Universal health coverage (UHC) has been achieved in South Korea and Taiwan. Diabetes-related avoidable hospitalization (DRAH) trends differ in the two health systems. Need factors are the major predictors of DRAHs in both systems under UHC. Physician visits and socioeconomic characteristics show different effects on DRAHs. Abstract: Quality of primary diabetes care is a key health policy concern in many OECD countries with an aging population. This cross-national, population-based study examined the extent and attributes of diabetes-related avoidable hospitalizations (DRAHs) in South Korea and Taiwan, both of which have social health insurance-based health systems with limited gate-keeping for hospitalizations. We analyzed comparable, nationally representative health insurance beneficiary datasets for the two countries (2002–2013), linked with community health resource data. The age- and sex-standardized DRAH rates were calculated, and multivariate, multi-level longitudinal modeling approaches were adopted. The DRAH rate decreased in Taiwan consistently during 2002–2013 and in Korea after 2011 only. Under the universal health coverage, people enjoyed high accessibility to care. A higher number of physician visits reduced DRAHs in Korea but not in Taiwan. Socio-economic disparities in DRAHs still existed in both countries, especially in Taiwan. We found a different trajectory in two similar health systems for the selected health system performance indicator for primary diabetes care. This can be partly explained by different policy approaches to diabetes management in the two countries over the years. Necessary are policy efforts to improve the quality and equality of primary diabetes care and better control of hospital admissions in these two health systems that provide generous access to care at a low cost in East Asia.