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Migration of labors is a worldwide phenomenon. Taiwan has similar problems of labor shortage as the economic infrastructure gradually developed into higher technology levels. After the government promulgated the law of "Arbeitsfoerderungsgesetz" on May 8 of 1992, the types and quantity of the legally employed alien workers have exceeded three hundred thousands in Taiwan. Research of alien workers in Taiwan so far have been focused the policy and management. In the health care field, the focus has been on the physical health examination of the alien workers. There lacks empirical study regarding the health status of alien workers in Taiwan, therefore, this study was intended to explore the medical utilization of alien workers in Taiwan under NHI system.
The objectives of this study aimed to understand the demographic characteristics of alien workers and their respective types of medical utilization. It also explored the predisposing, need, and enabling factors, as well as the resources available that lead to different medical utilization. The Behavior Model of Health Services Utilization developed by Aday and Andersen in 1980 was adopted as the theoretical framework. The alien workers included in this study were screened from the database of registered NHI population between January 1~ December 31, 1997. A total of 201,510 alien workers were identified. For each insured, the utilization data including Chinese and Western ambulatory care in 1997 were analyzed by using SPSS6.0 statistic software. Statistical methods used include X2 -test, t-test and one-way ANOVA, and multiple regression and multiple logistic regression.
The major findings of this study are as the followings:
1. Demographic characteristics: There are more males in the study population. The proportion of male and female is 3 to 1; the distribution of age group 26-35 was 56.7%, the age group 46-64 only has 3.6%; 79.8% of the alien workers was in the manufacturing segment.
2. Utilization of medical services and payment: 26.7% of the insured alien workers visited non-specific departments for ambulatory care, and 46.0% of them utilized surgical services of inpatient care. Majority of the medical payment was in the general disease category of ambulatory care, emergency care, traditional Chinese medicine care, and the inpatient care. The occupational diseases have a relative low share.
3. Utilization of Medical Care: 46.0% of the insured alien workers utilized ambulatory care, and the average number of ambulatory visits for the users per year was 3.30. The average expenditures were NT$1601.79 dollars per person per year. As for the study population, the average number of ambulatory visit was 1.52 per year, and the average expenditures was NT$737.52 dollars per person per year.
4. Utilization of emergency care: 5.1% of the insured alien workers utilized emergency services. The average number of emergency care per year was 1.12 visit for the users, and the average expenditures were NT$1855.62 dollars per year. As for the study population, the average number of emergency care visit per year was 0.05 per person, and the average expenditures was NT$94.94 dollars per year.
5. Utilization of ambulatory care in Chinese medicine: 3.0% of the insured alien workers utilized ambulatory Chinese medicine services. The average number of ambulatory Chinese medicine visit per year for the users was 1.59; the average expenditures were NT$712.10 dollars per year. As for the study population, the average number of ambulatory Chinese medicine visit per year was 0.05 per person, and the average expenditures was NT$21.46 dollars per year.
6. Utilization of Inpatient Services: 2.1%of the insured alien workers utilized hospital admission services. The average number of hospital admission per year for the users was 1.09, and the average hospital admission expenditures were NT$26536.72 dollars per year. The average number of hospital admission for the study population per year was 0.02 per person, and the average expenditures are NT$21.46 dollars per year.
7. Alien workers have less NHI medical utilization rate, frequency, and expenditures in comparison to the general public.
8. There are 20,492,317 insured persons in total in 1997 under NHI system. The total insurance premium revenue was NT$248.23 billions, and the total medical expenditures for that year were NT$237.1 billions. The premium of the alien worker was estimated to be NT$2.44 billions, and their medical expenditures should be NT$2.34 billions accordingly. The result of this showed an NT$280 millions medical expenditures instead. It is obvious that the alien workers have positive contribution to the NHI financial resources.
The author makes recommendations that the responsible governmental agencies should establish electronic case management system for the alien workers, and the health care providers should be aware of the patterns of medical utilization of the alien workers in order to provide adequate medical care to such group.
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