Ambulatory health care utilization of the older people under the National Health Insurance in Taiwan

Background/Purpose: To analyze and describe the patterns of ambulatory care utilization by the older people within the Taiwanese National Health Insurance (NHI) program. Methods: The nationwide computerized claims database of elderly ambulatory care visits under the NHI in 2004 was accessed. We obtained the complete outpatients service claim data sets of Western medicine for beneficiaries ≧ 65 years old. We then analyzed the pattern and frequency of visits by patient age, sex, and primary diagnosis. Results: In 2004, 96.6% of all elderly NHI beneficiaries had ever used ambulatory care service and there were totally 57,101,420 ambulatory care visits records from these elderly beneficiaries. The average ambulatory visit number of each beneficiary is 26.8 ± 22.7 (mean ± standard deviation) times per year, which was much higher than United States and other Organization for Economic Co-operation and Development countries. Nearly one-half of the elderly had more than 24 times visits annually. Female beneficiaries had higher average annual ambulatory visit number but lower mean medical expense per visit than male beneficiaries. The middle old age group (75-84 years old) had highest average visits numbers (29.2 ± 23.3) and highest average medical expense per visit: 37.1 US dollar. The three most frequent principal diagnoses of elderly ambulatory visits were diseases of the circulatory system (17.3%), diseases of the respiratory system (15.9%), and diseases of the musculoskeletal system and connective tissue (12.8%), respectively. While compared with United States data, the proportion of acute upper airway infection was much higher among old age ambulatory visits in Taiwan. Conclusion: The mean frequency of ambulatory visits of older people in Taiwan was high, especially in the middle-old age group. Health education and preventive services should focus on circulatory, respiratory, and musculoskeletal diseases, which accounted for nearly one-half of the primary diagnoses of old age ambulatory visits.