Healthcare utilization of bereaved family members following the 1999 Chi-chi earthquake: Evidence from administrative data

Objective: Strong earthquakes not only cause death and property damage, but also have continuous repercussions on the survivors' health. This study investigates the impact of the 1999 Chi-chi earthquake to understand how an earthquake disaster affects healthcare utilization differently between individuals who lost co-resident family members (victims) and those who did not (non-victims). Methods: We utilize the household registration records from the Ministry of the Interior as well as claim data from the Bureau of National Health Insurance in Taiwan from 1998 to 2000. Such datasets enable us to identify the relationship of the survivors with the dead and contain the residents' detailed healthcare utilization records. The difference-in-differences method is used to explore the changes in healthcare utilization. Results: Our results indicate that the victims had a higher probability of using inpatient care than the non-victims; and the victims who lost their parents tended to use more inpatient services than the other victims. As for the changes in outpatient utilization, the difference between victims and non-victims, and among victims who lost different family members appears to be statistically insignificant. Conclusion: Compared to non-victims, victims were more likely to use inpatient care after the Earthquake, particularly the victims who lost parents. However, the impacts of the Earthquake on outpatient care are statistically indifferent between victims and non-victims. One possible explanation is that the abundance of primary care and social support services provided by emergency medical assistance teams and/or non-governmental organizations after the Earthquake had substituted for regular outpatient utilization.