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Objectives: Four revised versions of Taiwan's abortion legislation were proposed in 2012 and raised controversy. Legislators led by Li-huan Yang proposed a six-day 'mandatory waiting periods' coupled with 'mandatory counseling'. Legislators led by Shi-bao Lai proposed 'consent from two doctors'. Both of these aimed to reduce the abortion rate and increase the birth rate. The Administrative Yuan for its part proposed a 'mandatory waiting period' of three days plus 'mandatory counseling'. And finally, legislators led by Yi-chen Wu proposed that medical institutions should provide all kinds of information related to abortion', and that local government 'should provide birth counseling to citizens'. This paper aims at analyzing the controversy. Methods: Three methods are adopted. (1) Discourse analysis is applied on documents collected from legal and medical research papers, government data and news reports. (2) Descriptive statistics is applied on two surveys conducted in 2007 and 2008 on women and obgynecologists nationwide respectively. (3) Text analysis is applied to the written texts provided by women and ob-gynecologists on some open-ended questions in the survey. Results: The 'Mandatory waiting periods' as proposed by Yang and the Administrative Yuan is found to lack consideration of reality, as our survey shows that most women considering the terminating of an unplanned pregnancy have already been thinking much longer than the stipulated period, typically having already done this for periods ranging from over one week to a whole month. As regards 'mandatory counseling', this is found to be in violation of human rights and professional ethics. As to 'consent from two doctors', this is found to create difficulties for women, and is opposed by a majority of ob-gynecologists. Conclusions: Two types of discourse appear in the controversy, the 'restrictive and controlling discourse' receives little support from academic research, or in surveys of women and physicians, and also runs counter to the professional ethics of counseling. Many research findings have shown that 'Mandatory waiting periods' do not contribute to the reduction of the abortion rate. The 'women centered discourse' reflects the women's needs and practice on the matter, and the 'patient centered discourse' practiced by ob-gynecologists can give support to 'women centered discourse'. As for an effective reduction of abortion rate, the paper finds that policy makers would achieve greater success by promoting greater use of contraceptives, and improving economic and social welfare, thus enabling women to consider keeping unplanned fetuses. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores the factors influencing the involvement of health-promoting Taiwanese elementary schools in school-family partnership. Methods: The study design was cross-sectional. A stratified random sample was used, according to the size of the districts and individual schools, to select participants from 2,675 primary schools in Taiwan. A total of 584 participants were recruited and the response rate was 67% (n=391). Structured questionnaires including items on demographics, predisposing factors, reinforcing factors, enabling factors, and involvement in school-family partnership, were used to collect data. The data were analyzed using descriptive statistics and hierarchy regression, and p < .05 was considered statistically significant. The research framework was based on the PRECEDE-PROCEED model. Results: The demographics, predisposing factors, reinforcing factors, and enabling factors were the major factors affecting school involvement in school-family partnership, accounting for 46.4% of the total variance for involvement in school-family partnership. The demographics, predisposing factors, reinforcing factors, and enabling factors can divided for 4.4%, 13.2%, 20.3% & 8.6% of the total variances. Conclusions: The availability of helpful resources, supportive policymaking, supportive principal, colleagues, and perceived efficacy of school-family partnership, can successfully enhanced school involvement in school-family partnership. [ABSTRACT FROM AUTHOR]

In the United States, the SEER-Medicare data link cancer patients in the SEER (Surveillance, Epidemiology, and End Results) Program with Medicare enrollment to identify cancer patients who are eligible for Medicare and to provide Medicare Claims for these patients. Statistics from the National Cancer Institute show that there are over 650 peer-reviewed publications using the SEER -Medicare database. This database has been the primary data source for health services research in oncology since its inception, and it has made tremendous contributions to policies related to cancer control, treatment, and surveillance in the United States. The National Health Insurance Research Database (NHIRD), established at the initiation of the Taiwan's National Health Insurance program in 1995, is a claims database. The Taiwan Cancer Database (TCDB), based on the Taiwan Cancer Registry, was established in 2002. The creation of a TCDB-NHIRD linked database could produce a SEER-Medicare-like database and has the potential to become an invaluable resource for cancer as well as policy researchers in Taiwan. This paper introduces the SEER-Medicare database, including data collection, software, applications of the database, data elements, structure, validation, the data request and application process, limitations of the database, and privacy and confidentiality issues. We then use a previously published breast cancer study to demonstrate the procedures involved in generating research from the SEER-Medicare database, followed by recommendations for the future development of a database that links TCDB to the NHIRD. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this paper was to investigate whether there was an improvement in the treatment outcomes for AMI patients in Yilan County after the opening of the Hsuehshan Tunnel on June 16, 2006. The Hsuehshan Tunnel connects Taipei City with Yilan County and substantially cuts down the traveling time between the two regions. It may facilitate the migration of medical manpower between the two regions and increase accessibility to medical center hospitals for Yilan's inhabitants. Methods: By using the 2004-2008 National Health Insurance Database, we estimated the changes in the 30-day mortality rate and readmission rate of Yilan's AMI patients via the logistic regression model and difference-in-differences. Results: We found that 30-day mortality rates for AMI patients in Yilan County did decline after the opening of the Hsuehshan Tunnel. This finding persisted when AMI patients in Yilan County and Hualien County were compared via difference-in-differences. There was also a decline in the readmission rates; however, it was not statistically significant. Conclusions: The treatment outcomes for Yilan's AMI patients did improve after the opening of the Hsuehshan Tunnel. Transportation facilities have a positive effect on the treatment outcomes for AMI patients living in less accessible areas because of the migration of medical manpower to regions with improved transportation. [ABSTRACT FROM AUTHOR]

The aim of this paper was to explore potential sources of revenue for National Health Insurance (NHI). Potential revenue sources considered were earmarked taxes on various substances including cigarettes, alcoholic beverages and betel nuts. A fat tax, a green tax, a luxury tax and a gambling tax were also considered. We reviewed the literature in this area of research, examined relevant financing policies in other countries, and discussed the benefits and costs associated with the proposed revenue sources. We suggest that the government raise the tax rates on tobacco and alcohol consumption to finance NHI. In addition, the government can tax sin goods such as betel nuts and sugar-sweetened beverages. In light of the negative externalities associated with gambling and pollution activities, the government can use parts of the green tax and the gambling tax to finance NHI. Finally, a luxury tax is also a good financing alternative due to its redistributive nature. We contend that, due to NHI's growing financial burden, it is imperative to find supplemental sources of revenue. [ABSTRACT FROM AUTHOR]

The National Health Insurance (NHI) officially promoted the global budget payment system in July 2002. Although this system effectively controlled insurance costs, approximately NT$60 billion in accrual deficit accumulated during 2009. The premium rate increased from 4.55% to 5.17% in 2010, temporarily relieving the NHI financial crisis. The main cause for the financial problems was the limited growth of premium revenues. To resolve this problem, major reforms in the payment methods of the NHI were enacted in 2013. In addition to maintaining the existing payment methods, the supplementary insurance premium on employers and beneficiaries were added. Although the supplementary insurance premium collected NT$40.2 billion during the first year of implementing the new financing mechanism, whether this mechanism is a short-term or long-term solution remains unknown. This study evaluated the balance of payment rates until 2023, indicating that the statutory premium rate ceiling (6%) will be exceeded within 10 years, at which time a reamendment of the NHI Act will likely be required. This study provided the balance of payment rate estimated according to various scenarios, which can be used as a reference by the authority when making future adjustments. [ABSTRACT FROM AUTHOR]

Following the Millennium Declaration in 2000, the United Nations introduced eight Millennium Development Goals (MDGs) to: 1) eradicate poverty, 2) achieve universal primary education, 3) promote gender equality, 4) reduce child mortality, 5) improve maternal health, 6) combat HIV/AIDS, malaria and other diseases, 7) ensure environmental sustainability, and 8) establish global partnerships for development. MDGs as a whole have profound implications for public health since each goal is a proven health determinant. From policy to research, these goals shape the landscape of global health. As the 2015 deadline approaches, the international community shows intensified interest in assessing progress and setting a new set of goals in the framework of sustainable development. This article traces the socio-political context of the emergence of MDGs, reviews current progress and emerging issues, and identifies Taiwan's gaps in knowledge and action. It concludes by urging Taiwan to pay closer attention to global development issues and to participate in the post-2015 forum. [ABSTRACT FROM AUTHOR]

Objectives: In the context of Confucian culture, the main unit of support for older parents in Taiwan is the family system. This points out the important connection between intergenerational relations and subjective economic strain. We utilized the intergenerational solidarity theory to explore whether "intergenerational emotional bond" (affection solidarity) predicted a lower level of subjective economic strain than did "received money from children" (functional solidarity). Methods: This study used data from the Taiwan Longitudinal Study on Aging, a nationally representative sample of older adults aged 60 and above, collected between 1989 and 2003. Generalized linear modeling with GEE estimates was employed because of the repeated measures. Results: After SES and other covariates were controlled, females who felt that their children were reliable when they were sick were 0.36 points lower on the four point scale of economic strain (β=-0.36, p<0.001) while those who received monetary support from sons were 0.09 points lower (β=-0.09, p<0.001). Males who felt that their children were reliable when they were sick were also less likely to experience economic strain (β=-0.22, p<0.001); however, the effect of monetary support from sons was insignificant. Conclusions: These findings suggest that "children's care" produced a stronger and more positive effect on alleviating parents' subjective economic strain than did monetary support. Health and Welfare policy makers promoting economic well-being among older adults should take mutual emotional respect and an understanding of intergenerational relations into consideration. [ABSTRACT FROM AUTHOR]

Objectives: Improvements in the quality and quantity of life are equally important based on the concepts of successful aging and active aging. These include physical, mental and social well-being in old age. Instead of the past emphasis on improving morbidity or malfunction, the goal for health care of the elderly should focus on actively improving their comfort and overall quality of life. Methods: In order to explore the factors affecting the long term changes in the trends of successful aging and active aging of older people in Taiwan, we analyzed the data from a survey of Health and Living Status of the Elderly in Taiwan conducted by the Health Promotion Administration, Ministry of Health and Welfare. Using the interpolated Markov chain approach, we projected the prevalence and healthy life expectancy. We also investigated the effects of chronic diseases e.g. hypertension, heart disease and diabetes on the differences in healthy life expectancy, successful aging, and active aging. Results: The influence of variables which positively affected successful aging and active aging declined as age increased. Similar results were observed for prevalence. For successful aging, healthy life expectancy accounted for approximately 40-50% of all life expectancy; of this, active aging accounts for about 15-25%. For each age group, diabetes lowered the percentage of healthy life expectancy compared to hypertension and heart disease. Conclusions: Achieving a high quality of active aging is an ideal goal for the government and health institutes. Among chronic diseases, diabetes had the most serious impact on healthy life expectancy and its prevention and treatment should be emphasized. [ABSTRACT FROM AUTHOR]

Objectives: Bullying is an important public health issue. The aims of this study were to demonstrate the prevalence of bullying roles and to investigate individual and family correlates of these roles among 7th to 9th graders in Taiwan. Methods: Participants included 3,441 students from 120 classes in 20 schools via stratified, multistage, random cluster sampling. To estimate the prevalence of roles in bullying, the weighting index was calculated from the inverse of the sampling rates. Descriptive analysis and multinomial logistic regression were performed using SAS Survey Analysis PROCs software. Results: Our survey revealed that 18.63% of the students were involved in bullying with 8.71% as bullies, 7.01% as victims, and 2.91% in both roles. Gender, level of impulsiveness, self-perceived popularity, parental educational attainment, the frequency of family conflict, scolding, and corporal punishment were significantly related to the probability of being classified in one bullying role or another. Conclusions: School bullying is not uncommon in Taiwan. Our results suggested that individual characteristics and family factors associated with bullying roles should be taken into account in the development of programs to prevent bullying. [ABSTRACT FROM AUTHOR]

Objectives: This study compared the utilization of and requirements for primary healthcare services for residents living in remote and non-remote areas of Hualien County. Methods: We used quantitative questionnaires to survey 6 townships in remote areas and 3 townships in non-remote areas of Hualien County. The questionnaire gathered data about demographics, utilization of primary healthcare services, and the needs for medical care, preventive care, and health education services. A total of 573 valid questionnaires were retrieved for a response rate of 97%. In addition, 10 village heads of villages in remote/non-remote areas were invited to participate in qualitative interviews. Results: The results indicated that 49.3% of residents in remote areas thought that medical resources were inadequate, while only 16.6% of the residents in non-remote areas held the same opinion. Results also showed a need to strengthen various departments of healthcare services in villages and townships. Ophthalmology was the most needed medical service in remote areas, while family medicine was the most needed in non-remote areas. Mobile medical services were also needed for residents living in remote areas, while those living in non-remote areas emphasized a need for the reduction in payments for medical care. The qualitative in-depth interviews showed that the attitudes of village or neighborhood leaders were highly correlated with the availability of medical resources. Conclusions: Access to primary health care centers was similar in remote and non-remote areas; however, the residents in remote areas had a relatively lower level of satisfaction with health care services. We suggest that healthcare authorities consider specific service items and quality when determining the deployment of health care services in remote areas. [ABSTRACT FROM AUTHOR]

This article, inspired by the concept of human security, studies the development of health issues within the framework of Asia-Pacific Economic Cooperation (APEC)by looking at the institutional evolution of the Health Task Force (HTF) from a temporary task force to a permanent Health Working Group (HWG). Issues linking health, economics, food, and emergency preparedness are examined. We discuss the broad concepts of human security and their applications to international affairs. After a review of APEC health issues, the human security perspective is applied to describe the historical phases of the HTF. This study combines viewpoints from human security and the health regime to evaluate the effectiveness of Taiwan's participation in APEC health issues. Policy suggestions are also provided. [ABSTRACT FROM AUTHOR]