Inadequate Healthcare Utilization in Young Children Receiving Children Welfare Services in Taiwan

Introduction: Children from families characterized by high-risk indicators (e.g. financial difficulty or parental substance use disorders) are disproportionally under-representative in healthcare-seeking population. Healthcare under-utilization is critically worrisome for the first years of life when health and development are vulnerable to risk such as poverty and maltreatment. In the context of universal health insurance coverages, the present study aims to investigate the pattern of healthcare utilization in young children receiving the Children Welfare Service (CWS) high-risk family intervention and probe potential individual- and family-level explanatory factors.

Methods: Building on the national administrative datasets concerning healthcare (i.e. National Health Insurance Research Database [NHIRD]) and social welfare service (i.e. National Case Client Data of High-Risk Child and Youths) in Taiwan, we identified 5308 children received high-risk family intervention of CWS before the age of six during the calendar years of 2012-2015. For comparison, a total of 53080 birth year-, birth month-, sex-, and residence-matched children were randomly drawn from the NHIRD. Through encrypted identification number, healthcare utilization records for both groups were obtained from the NHIRD. Chi-square test and the generalized linear model/ generalized estimating equation (GLM/GEE) methods were used to explore utilization pattern and examine individual sociodemographic and health predictors.

Results: An estimated 89% of young children ever had outpatient visits in the twelve months preceding the CWS’ high-risk family intervention, and the corresponding estimate was 92% in their matched peers. Notably, an excess in emergency room (ER, 39%) and inpatient care (18%) were noted in the young children later served by the CWS (vs. 27% and 10% in the matched children). Probable inadequate utilization of healthcare was especially prominent for certain individual characteristics (e.g., age and unfavorable birth condition) and family attributes (e.g., parents with substance use problems).

Conclusions: Children from less developmentally disadvantageous families generally under-utilized healthcare services before the CWS intervention. Healthcare and social service providers should safeguard children with unmet needs in healthcare.