The impact of national health insurance on the notification of tuberculosis in Taiwan.
METHODS
General notification of tuberculosis in Taiwan.


OBJECTIVE
To ensure the completeness of notification of tuberculosis (TB) in Taiwan, the Bureau of National Health Insurance (NHI) introduced two policies in 1997: 1) the no-notification-no-reimbursement (NNNR) policy, and 2) the notification-fee (NF) policy. The goals of this study were to investigate the impact of the NNNR and NF policies on notification of TB.


METHODS
Review of all cases notified to the National TB Register from 1995 to 1999 to determine calendar trend, type of case and source of notification.


RESULTS
There were 11,453 and 13,612 reported cases in 1995 and 1996, respectively. Following the implementation of the NHI policies, there was a 47% increase in 1997, with 20 021 reported cases. Quarterly reporting of cases reached a historic peak in the third quarter of 1997. The increase in reported cases was mainly from general hospitals/clinics. Since 1998, the number of reported cases has declined steadily, at a rate of 7% and 3% in 1998 and 1999, respectively.


CONCLUSIONS
The NNNR and NF policies had a significant impact on notification of TB in Taiwan. These policies substantially improved completeness of reporting, an observation with implications for surveillance of other reported diseases.
Chiang
C Y
CY
Chronic Disease Control Bureau, Department of Health, Taipei, Taiwan. jones1@ms7.hinet.net
Enarson
D A
DA
Yang
S L
SL
Suo
J
J
Lin
T P
TP
D018563:Disease Notification / Q000706:statistics & numerical data*; D018166:Health Care Reform; D006801:Humans; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D009313:National Health Programs / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012042:Registries; D013624:Taiwan; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*