Access and utilization of healthcare among infants with mothers in Methadone Maintenance Treatment in Taiwan

Objective: This study investigated the insurance coverage for offspring of mothers in the Methadone Maintenance Treatment (MMT) and examined the relationships between infant's preventive service and curative care utilization with maternal illegal drug treatment history.

Methods: Data were obtained from the national MMT database, the National Birth Notification and Registration Databases, and the National Health Insurance Research Database. Through data linkage, we identified 199 infants with mothers in the MMT, and 1:10 controls matching on birth year (2006-2008), maternal age, and socioeconomic status (primarily lower SES); 258 were identified as the other control group when their non-MMT enrolled mothers had illegal drug problems visits (ICD-9CM code: 304, 305) within the year prior to delivery. Logistic and two-part regression models were employed to evaluate the association estimates.

Results: Even when national health insurance is enforced, only 54% of children with mothers in the MMT received continued insurance coverage in the first year of life. With potential confounders adjusted, infants with MMT enrolled mothers were at 1.4-fold risk to have no/discontinued health insurance (P < 0.01) as compared to those with matched mothers; the visits for well-baby preventive service and curative healthcares were significantly lowered (β=-0.45 and -0.01). Relationship estimates were slightly greater when in comparison with those born to drug-using control (adjusted Odds Ratio=2.3; β=-0.40, -0.83, Ps<.001).

Conclusion: Harm reduction programs for women with child-bearing ages should be delivered in coordinated care systems that ensure the comprehensiveness and continuum in healthcare, child welfare, and social service.