The effect of universal health insurance on health care utilization in Taiwan. Results from a natural experiment.
BACKGROUND
The government of Taiwan introduced universal health insurance to cover all citizens in 1995. This national health insurance program was proposed to assure the accessibility to health care at reasonable cost. Evaluation of the consequences, including health care utilization and expenditure, is crucial for policy adjustment.


OBJECTIVE
To evaluate the effect of Taiwan's national health insurance on health care utilization.


METHODS
Cohort survey conducted before and after the implementation of the national health insurance program.


METHODS
A total of 1021 randomly selected Taiwanese adults.


METHODS
Physician visits in the 2 weeks prior to the survey and hospital admissions and emergency department visits in the immediate past year.


RESULTS
After the introduction of universal health insurance, the newly insured consumed more than twice the amount of outpatient physician visits (0.21 vs 0.48, P<.05) and hospital admissions (0.04 vs 0.11, P<.05) than before universal health insurance was implemented, bringing them to the same amount of health care contacts as the previously insured group. The newly insured also experienced an insignificant increase in emergency department visits. In contrast, the previously insured group had a small but statistically significant increase in outpatient visits (0.48 vs 0.59, P<.05) and insignificant changes in hospital admissions and emergency department visits.


CONCLUSIONS
The universal health insurance removed some barriers to health care for those newly insured. The copayment design in the insurance scheme seemed to have an insignificant effect on curbing medical care utilization. Taiwanese health policy analysts should seriously consider the growth of health care expenditures since the implementation of universal health insurance.
Cheng
S H
SH
Graduate Institute of Public Health and Center for Health Policy Research, College of Public Health, National Taiwan University, Taipei. shcheng@ntumc1.mc.ntu.edu.tw
Chiang
T L
TL
D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006291:Health Policy; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000191:economics / Q000639:trends; D012494:Sampling Studies; D012959:Socioeconomic Factors; D013624:Taiwan; D019472:Universal Health Insurance