Disparities in primary prevention: A panel study on the receipt of free health examination for the elderly under the National Health Insurance in Taiwan

Objective: Taiwan's National Health Insurance (NHI) program provides free and comprehensive annual health examination service for the elderly aged over 65 as an important way of primary prevention. This study assessed the extent to which disparities in receiving this prevention service exist among elderly beneficiaries by gender, race/ethnicity, socioeconomic status (SES) and supply side factors under Taiwan's NHI.

Method: Instead of cross-sectional analysis, we conducted a longitudinal study by using a fixed random cohort sample (N=5419) between 1998 and 2002 from the NHI claim and administration files. The method of Generalized Estimating Equations was adopted to estimate the pattern of receiving annual health check-up during the 5year study period.

Results: There were no significant disparities among the elderly by gender and race. The elderly who had ever sought to outpatient services for chronic diseases were more 34% (OR=1.337, CI= (1.239, 1.442)) likely to have the routine examination than those who had no histories of chronic diseases. The elderly in higher-income group was more 10% (OR=1.103, CI= (1.021, 1.194)) likely to use the routine check-up than those people in lower-income group. The elderly living in areas with higher density of medical resources was more 18% (OR=1.183, CI= (1.062, 1.318)) likely to use the routine check-up.

Conclusions: Although gender and race are both insignificant disparity factors under universal NHI, our results indicate the presence of access differentials go beyond direct financial barriers. Attention should be focused on health education, resource allocation, and lower social economic status groups.