Journal of the Chinese Medical Association
Volume 73, Issue 5 , Pages 252-259, May 2010

Factors Influencing the Intention to Utilize Out-of-Pocket Health Checkup Services: A Sample of Citizens From 12 Townships of Taichung County in Taiwan

  • Yuh-Shiow Lee

      Affiliations

    • Secretarial Office, Fung-Yuan Hospital, Department of Health, Executive Yuan, Fung-Yuan
    • Department of Health Care Administration, Central Taiwan University of Science and Technology, Taichung, Taiwan, R.O.C.
    • ,
  • Yen-Lin Chiu

      Affiliations

    • Department of Leisure and Recreation, Asia University, Taichung, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Yen-Lin Chiu, 2, Lane 99, Letian Street, Fongyuan, Taichung 420, Taiwan, R.O.C.
    • ,
  • Hui-Ling Liao

      Affiliations

    • Division of Pharmacy, Fung-Yuan Hospital, Department of Health, Executive Yuan, Fung-Yuan
    • Institute of Chinese Pharmaceutical Sciences, China Medical University, Taichung, Taiwan, R.O.C.
    • ,
  • Jin-Tang Chen

      Affiliations

    • Superintendent, Fung-Yuan Hospital, Department of Health, Executive Yuan, Fung-Yuan
    • ,
  • Fu-Chun Lee

      Affiliations

    • Division of Family Medicine, Fung-Yuan Hospital, Department of Health, Executive Yuan, Fung-Yuan

Received 3 June 2009; accepted 6 April 2010.

Article Outline

Abstract 

Background

Taiwan started its National Health Insurance (NHI) system in 1995. However, until now, most cancer screening tests and preventive care have been out-of-pocket (OOP) medical items excluded from the coverage of NHI. The aim of this study was to explore the factors influencing an individual's intention to utilize OOP health checkups.

Methods

A cross-sectional research method was adopted in this study. Based on the theory of planned behavior, a questionnaire was developed and used to survey purposively sampled residents (n = 940) from 12 randomly selected townships in Taichung County, Taiwan, from August to September 2006. Descriptive statics and linear regression were conducted to analyze the collected data.

Results

Our results showed that result evaluation (β = 0.092), behavioral beliefs (β = 0.088), behavioral norms of people with experience in utilizing OOP health checkups (β = 0.116), perceived convenience (β = 0.273), and worry about illness and perceived health (β = 0.110) were important factors influencing the intention to utilize OOP health checkups. Age, education and acceptable health checkup charges were also related.

Conclusion

Reinforcing disease- and health checkup-related knowledge may positively influence an individual's intention to utilize OOP health checkups. In addition, improving perceived convenience and reducing disease-screening barriers can intensify the individual's intention to use OOP health checkups. The influence of age, education level and OOP checkup charges should also be taken into consideration when related policies are formulated.

Key Words:  disease screening , health checkup , out-of-pocket , theory of planned behavior

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References 

  1. Department of Health, Executive Yuan, R.O.C. (Taiwan)  . Cause of Death Statistics . Available at: http://www.doh.gov.tw/CHT2006/DM/DM2_2_p02.aspx?class_no=440&now_fod_list_no=10642&level_no=3&doc_no=73104 2007; [Date accessed: December 21, 2009; In Taiwanese]
  2. Department of Health, Executive Yuan, R.O.C. (Taiwan)  . National Health Insurance Annual Statistical Report . Available at: http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=10904&class_no=440&level_no=3 2007; [Date accessed: December 21, 2009; In Taiwanese]
  3. Department of Health, Executive Yuan, R.O.C. (Taiwan)  . Taiwan Public Health Report . Available at: http://www.doh.gov.tw/ufile/doc/97%e5%85%ac%e5%85%b1%e8%a1%9b%e7%94%9f.pdf 2007; [Date accessed: December 21, 2009; In Taiwanese]
  4. Aday LA , Andersen R . A framework for the study of access to medical care . Health Serv Res . 1974;9:208–220
  5. Rosenstock IM , Strecher VJ , Becker MH . Social learning theory and the health belief model . Health Educ Q . 1988;15:175–183
  6. Fishbein M , Ajzen I . Beliefs, Attitudes, Intentions and Behavio . New York: Wiley; 1975;
  7. Ajzen I . The theory of planned behavior . Organ Behav Hum Decis Process . 1991;50:179–211
  8. Aday LA , Andersen R . Equity of access to medical care: a conceptual and empirical overview . Med Care . 1981;19:4–27
  9. Ahmad F , Cameron JI , Stewart DE . A tailored intervention to promote breast cancer screening among South Asian immigrant women . Soc Sci Med . 2005;60:575–586
  10. Bunn JY , Bosompra K , Ashikaga T , Flynn BS , Worden JK . Factors influencing intention to obtain a genetic test for colon cancer risk: a population-based study . Prev Med . 2002;34:567–577
  11. Ajzen I . Behavioral iIintervention Based on the Theory of Planned Behavior . Available at: http://people.umass.edu/aizen/pdf/tpb.intervention.pdf [Date accessed: December 25, 2009]
  12. Ajzen I , Madden T . Prediction of goal-directed behavior: attitude, intentions and perceived behavioral control . J Exp Soc Psychol . 1986;22:453–474
  13. Schifter DB , Ajzen I . Intention, perceived control and weight loss: an application of the theory of planned behavior . J Pers Soc Psychol . 1985;49:843–851
  14. Armitage CJ , Conner M . Efficacy of the theory of planned behavior: a meta-analytic review . Br J Soc Psychol . 2001;40:471–499
  15. Godin G , Kok G . The theory of planned behavior: a review of its applications to health-related behaviors . Am J Health Promot . 1996;11:87–98
  16. Fernández-Esquer ME , Cardenas-Turanzas M . Cervical cancer screening among Latinas recently immigrated to the United States . Prev Med . 2004;38:529–535
  17. McCaffery K , Wardle J , Waller J . Knowledge, attitudes, and behavioral intentions in relation to the early detection of colorec-tal cancer in the United Kingdom . Prev Med . 2003;36:525–535
  18. Myers RE, Ross E, Jepson C, Wolf T, Balshem A, Millner L, et al. Modeling adherence to colorectal cancer screening . Prev Med . 1994;23:142–151
  19. Sheeran P , Conner M , Norman P . Can the theory of planned behavior explain patterns of health behavior change? . Health Psychol . 2001;20:12–19
  20. Yu MN . The computation of content validity coefficient and homogeneity reliability coefficient in ordinal data . Psycho Test . 1993;40:199–214
  21. Department of Budget, Accounting and Statistics  , Taichung County Government  . Age Distribution of Residents in Taichung County . Available at: http://account.taichung.gov.tw/pxweb2007P/Dialog/statfile9L.asp [Date accessed: December 25, 2009; In Taiwanese]
  22. Wu S . Sickness and preventive medical behavior . J Health Econ . 2003;22:675–689
  23. Brenes GA , Paskett ED . Predictors of stage of adoption for colorectal cancer screening . Prev Med . 2000;31:410–416
  24. Lairson DR , Chan W , Newmark GR . Determinants of the demand for the breast cancer screening among women veterans in the United States . Soc Sci Med . 2005;61:1608–1617
  25. Cornelius LJ , Smith PL , Simpson GM . What factors hinder women of color from obtaining preventive health care? . Am J Public Health . 2002;92:535–539
  26. Kelly RB , Shank JC . Adherence to screening flexible sigmoido-scopy in asymptomatic patients . Med Care . 1992;30:1029–1042
  27. Becker MH , Drachman RH , Kirscht JP . A new approach to explaining sick-role behavior in low-income populations . Am J Public Health . 1974;64:205–216
  28. Jopson R , Clegg A , Forbes C , Lewis R , Snowden A , Kleijnen J . The determinants of screening uptake and interventions for screening uptake: a systematic review . Health Technol Assess . 2000;4:1–133
  29. Mullahy J . It'll only hurt a second? Microeconomic determinants of who gets flu shots . Health Econ . 1999;8:9–24
  30. Cherkin DC , Grothaus L , Wagner EH . The effect of office visit copayments on preventive care services in an HMO . Inquiry . 1990;27:24–38
  31. Kane RL , Johnson PE , Town RJ , Butler M . A structured review of the effect of economic incentives on consumers' preventive behavior . Am J Prev Med . 2004;27:327–352
  32. Barr JK, Reisine S, Wang Y, Holmboe EF, Cohen KL, Van Hoof TJ, et al. Factors influencing mammography use among women in Medicare managed care . Health Care Financ Rev . 2001;22:49–61
  33. Dubé CE , Fuller BK , Rosen RK , Fagan M , O'Donnell J . Men's experiences of physical exams and cancer screening tests: a qualitative study . Prev Med . 2005;40:628–635
  34. Price JH . Perceptions of colorectal cancer in a socioeconomically disadvantaged population . J Community Health . 1993;18:347–362
  35. Tolma EL , Reininger BM , Ureda J , Evans A . Cognitive motivations associations associated with screening mammography in Cyprus . Prev Med . 2003;36:363–373
  36. Sieverding M , Matterne U , Ciccarello L . What role do social norms play in the context of men's cancer screening intention and behavior? Application of an extended theory of planned behavior . Health Psychol . 2010;29:72–81
  37. Cooke R , French DP . How well do the theory of reasoned action and theory of planned behaviour predict intention and attendance at screening programmes? A meta-analysis . Psychol Health . 2008;23:745–765

PII: S1726-4901(10)70054-X

doi:10.1016/S1726-4901(10)70054-X

Journal of the Chinese Medical Association
Volume 73, Issue 5 , Pages 252-259, May 2010

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