Shu-ling Tsai

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Papers by Shu-ling Tsai

Effects of Changes in Diabetes Pay-for-Performance Incentive Designs on Patient Risk Selection

by Hui-min Hsieh and Shu-ling Tsai

Health Services Research, 2015

Taiwan&amp;amp;#39;s National Health Insurance (NHI) Program implemented a Diabetes Pay-for-P... more Taiwan&amp;amp;#39;s National Health Insurance (NHI) Program implemented a Diabetes Pay-for-Performance Program (P4P) based on process-of-care measures in 2001. In late 2006, that P4P program was reformed to also include achievement of intermediate health outcomes. This study examined how the change in design affected patient risk selection. Study populations were identified from a 2002 to 2003 period (Phase 1) and a 2007 to 2008 period (Phase 2), spanning pre- and postimplementation of reforms in the P4P incentive design. Phase 1 had 74,529 newly enrolled P4P patients and 215,572 non-P4P patients, and Phase 2 had 76,901 newly enrolled P4P patients and 299,573 non-P4P patients. Logistic regression models were used to estimate the effect of changes in design on P4P patient selection. Patients with greater disease severity and comorbidity were more likely to be excluded from the P4P program in both phases. Furthermore, the additional financial incentive for patients&amp;amp;#39; intermediate outcomes moderately worsened patient risk selection. Policy makers need to carefully monitor the care of the diabetes patients with more severe and complex disease statuses after the changes of P4P financial incentive design.

Cost-Effectiveness of Diabetes Pay-for-Performance Incentive Designs

by Hui-min Hsieh and Shu-ling Tsai

Medical Care, 2014

Background: Taiwan's National Health Insurance (NHI) Program implemented a diabetes pay-for-perfo... more

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Out-of-pocket payment for medical care under Taiwan's National Health Insurance system

by Chunhuei Chi and Shu-ling Tsai

Health economics, 2008

The objective of this study is to estimate the amount of and factors associated with out-of-pocke... more The objective of this study is to estimate the amount of and factors associated with out-of-pocket (OOP) payment for medical care under Taiwan's National Health Insurance (NHI) program. This research used two methods to collect original data. The first method consisted of using a sample household survey and household diary records to collect data on OOP payment prospectively over a two-month period from a random sample of 600 households in central Taiwan. Using the individual as the unit of analysis, we obtained a total of 1062 sample subjects. To ascertain the quality and accuracy of survey data, the claim records of the bureau of NHI were merged with the survey data. These data were analyzed by a two-part model, with a probit model for use of health care and an ordinary least-squares model for OOP payments. Results of this research indicate that on average an individual's annual OOP payment for medical care was euro 247, which is substantial, compared with the average euro...

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Suicides after the 1999 Taiwan earthquake

by Shu-ling Tsai and Yu-wei Chou

Natural disasters affect millions of people each year. Many are injured, or suffer the pain of lo... more Natural disasters affect millions of people each year. Many are injured, or suffer the pain of losing loved ones, and the majority sustain property damage. A devastating earthquake rating 7.3 on the Richter scale hit central Taiwan in the early morning of 21 September 1999. It was the biggest earthquake since 1935, killing more than 2400 people, injuring another 11 000, and destroying 105 000 houses. 1 For those surviving the earthquake, the aftermath was a dramatic life event. Causal pathways, leading from trauma to psychological consequences upon the death of a spouse or child, 2-5 socioeconomic crisis, 6-14 or physical disability and sickness, 7,13-17 have been extensively discussed in the literature. It suggests that the increase in stress (physical and emotional) and grief, the loss of social network, and the diminishing material support resulting directly or indirectly from traumatic events could increase the incidence of mental illness, and lead to suicidal ideation or completed suicides. Even though some significant disaster-related effects upon mental health, such as depression and post-traumatic stress disorder (PTSD), have been identified, the impact of disaster on extreme post-traumatic responses by some victims, such as suicide, remains unclear. To date, only a few papers have specifically studied the impact of earthquakes on suicide. The study by Krug and colleagues examined the association between suicides and earthquakes. Despite the large size of the affected population in their study they did not observe a IJE vol.32 no.6 Background The impact of a disaster on extreme post-traumatic responses of the victims, such as suicide, remains unclear. We conducted this study to investigate the risk of committing suicide between victims and non-victims after the 1999 Taiwan earthquake.

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Involuntary unemployment and mortality in Taiwan

Journal of the Formosan Medical Association = Taiwan yi zhi, 2004

Unemployment is known to be associated with increased mortality, but little data is available fro... more Unemployment is known to be associated with increased mortality, but little data is available from Taiwan, where dramatic structural changes in the economy have increased unemployment in recent years. The aim of this study was to investigate the effect of unemployment on mortality in Taiwan. The study design was a cohort study with a control group. The unemployed group included 92,563 involuntarily unemployed individuals in 2001. Those in the control group (n = 92,599) were randomly selected from 1,230,000 employees, and matched with those in the unemployed group, by age, gender, income, firm size and urbanization, using a frequency matching mechanism. All subjects were followed during the period from January 2001 to December 2002. The adjusted hazard ratio was estimated using the Cox proportional hazards model. After adjusting for other factors, unemployment was associated with a higher risk of mortality (hazard ratio, 1.99; 95% confidence interval [CI], 1.60-2.48). The gender-spec...

Structure Determines Medication Errors in Nursing Units: A Mechanistic Approach

by B.-o. Lee and Shu-ling Tsai

Western Journal of Nursing Research, 2013

Medication errors have long been considered critical in global health care systems. However, few ... more Medication errors have long been considered critical in global health care systems. However, few studies have been conducted to explore the effects of nursing unit structure on medication errors. The purpose of this study, therefore, was to determine the effects of structural factors on medication errors in nursing units. A total of 977 staff nurses and 62 head nurses participated in this cross-sectional design study. The findings show that professional autonomy (β = .53, t = 6.03, p < .01), technology (β = .25, t = 3.02, p < .01), and nursing experts (β = .52, t = 5.99, p < .01) are predictors of medication error rates. This study shows that the structural factors influence medication administration and the mechanistic approach is specifically in relation of low medication error rates. The author suggests that head nurses should consider strategies that require adjustments to unit control mechanisms.

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Ensuring the sustainability of the Taiwan National Health Insurance

by San-kuei Huang and Shu-ling Tsai

Journal of the Formosan Medical Association, 2014

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Using Health Smart Cards to Check Drug Allergy History: The Perspective from Taiwan’s Experiences

Journal of Medical Systems, 2011

In Taiwan, national health insurance coverage began in 1994, and the Bureau of National Health In... more In Taiwan, national health insurance coverage began in 1994, and the Bureau of National Health Insurance has issued health smart cards since 2004. In addition to tracking medical reimbursements, these smart cards store healthcare information, including electronic prescriptions, medical procedure and vaccination records, drug allergy histories, and information about a patient's willingness to be an organ donor. We conducted this study 4 years after the smart cards had been introduced in order to review how drug allergy history is recorded using this system. Our results reveal that the drug allergy histories are incomplete in many cases, and the format used to record a patient's drug allergy history is not consistent. We offer suggestions to promote the standardization of drug allergy history records.

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The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: A population-based study

Health Policy, 2012

Objective: To examine the impacts of diagnosis-related group (DRG) payments on health care provid... more Objective: To examine the impacts of diagnosis-related group (DRG) payments on health care provider's behavior under a universal coverage system in Taiwan. Methods: This study employed a population-based natural experiment study design. Patients who underwent coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty, which were incorporated in the Taiwan version of DRG payments in 2010, were defined as the intervention group. The comparison group consisted of patients who underwent cardiovascular procedures which were paid for by fee-for-services schemes and were selected by propensity score matching from patients treated by the same group of surgeons. The generalized estimating equations model and difference-in-difference analysis was used in this study. Results: The introduction of DRG payment resulted in a 10% decrease (p < 0.001) in patient's length of stay in the intervention group in relation to the comparison group. The intensity of care slightly declined with p < 0.001. No significant changes were found concerning health care outcomes measured by emergency department visits, readmissions, and mortality after discharge. Conclusion: The DRG-based payment resulted in reduced intensity of care and shortened length of stay. The findings might be valuable to other countries that are developing or reforming their payment system under a universal coverage system.

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Out‐of‐pocket payment for medical care under Taiwan's National Health Insurance system

Health Economics, 2008

The objective of this study is to estimate the amount of and factors associated with out-of-pocke... more The objective of this study is to estimate the amount of and factors associated with out-of-pocket (OOP) payment for medical care under Taiwan's National Health Insurance (NHI) program. This research used two methods to collect original data. The first method consisted of using a sample household survey and household diary records to collect data on OOP payment prospectively over a two-month period from a random sample of 600 households in central Taiwan. Using the individual as the unit of analysis, we obtained a total of 1062 sample subjects. To ascertain the quality and accuracy of survey data, the claim records of the bureau of NHI were merged with the survey data. These data were analyzed by a two-part model, with a probit model for use of health care and an ordinary least-squares model for OOP payments. Results of this research indicate that on average an individual's annual OOP payment for medical care was h 247, which is substantial, compared with the average h 144 for per capita NHI earmarked tax. Finally, results of model estimation indicate that supplemental health insurance and household income were positively associated with any use of health care, while household income was also positively associated with OOP payment for health care.

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Comparison of tolerance and change of intragastric pH between early nasogastric and nasojejunal feeding following resection of colorectal cancer

Clinical Nutrition, 2006

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Who Is at Risk of Death in an Earthquake?

American Journal of Epidemiology, 2004

Although, theoretically, the impacts of a disaster are not randomly distributed across health and... more Although, theoretically, the impacts of a disaster are not randomly distributed across health and socioeconomic classes, empirical evidence of this claim is scarce. In a population-based cohort study, the authors identified risk factors for mortality from the September 21, 1999, Taiwan earthquake, which occurred in the middle of the night. Among 297,047 earthquake victims in central Taiwan who experienced partial or complete dwelling damage, 295,437 (noncases) survived the earthquake and 1,610 (cases) died between September 21 and October 31, 1999. Odds ratios were adjusted for both micro-level individual variables and macro-level neighborhood variables. People with mental disorders (odds ratio (OR) = 2.0, 95% confidence interval (CI): 1.1, 3.5), people with moderate physical disabilities (OR = 1.7, 95% CI: 1.2, 2.3), and people who had been hospitalized just prior to the earthquake (OR = 1.4, 95% CI: 1.2, 1.7) were the most vulnerable. The degree of vulnerability increased with decreasing monthly wage (measured in New Taiwanese dollars (NT$)) (NT$20,000∼NT$39,999: OR = 1.5, 95% CI: 1.1, 2.1; <NT$20,000: OR = 2.2, 95% CI: 1.6, 3.0). The significant associations of both prequake health status and socioeconomic status with earthquake death suggest that earthquake death did not occur randomly. These results might help to guide allocation of public resources for reducing casualties.

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The Secular Trends in the Incidence Rate and Outcomes of Out-of-Hospital Cardiac Arrest in Taiwan-A Nationwide Population-Based Study

by Shu-ling Tsai and Likwang Chen

PloS one, 2015

This study investigated the trends in incidence and mortality of out-of-hospital cardiac arrest (... more This study investigated the trends in incidence and mortality of out-of-hospital cardiac arrest (OHCA), as well as factors associated with OHCA outcomes in Taiwan. Our study included OHCA patients requiring cardiopulmonary resuscitation (CPR) upon arrival at the hospital. We used national time-series data on annual OHCA incidence rates and mortality rates from 2000 to 2012, and individual demographic and clinical data for all OHCA patients requiring mechanical ventilation (MV) care from March of 2010 to September of 2011. Analytic techniques included the time-series regression and the logistic regression. There were 117,787 OHCAs in total. The overall incidence rate during the 13 years was 51.1 per 100,000 persons, and the secular trend indicates a sharp increase in the early 2000s and a decrease afterwards. The trend in mortality was also curvilinear, revealing a substantial increase in the early 2000s, a subsequent steep decline and finally a modest increase. Both the 30-day and 1...

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