The impact of universal National Health Insurance on population health: the experience of Taiwan.
BACKGROUND
Taiwan established a system of universal National Health Insurance (NHI) in March, 1995. Today, the NHI covers more than 98% of Taiwan's population and enrollees enjoy almost free access to healthcare with small co-payment by most clinics and hospitals. Yet while this expansion of coverage will almost inevitably have improved access to health care, however, it cannot be assumed that it will necessarily have improved the health of the population. The aim of this study was to determine whether the introduction of National Health Insurance (NHI) in Taiwan in 1995 was associated with a change in deaths from causes amenable to health care.


METHODS
Identification of discontinuities in trends in mortality considered amenable to health care and all other conditions (non-amenable mortality) using joinpoint regression analysis from 1981 to 2005.


RESULTS
Deaths from amenable causes declined between 1981 and 1993 but slowed between 1993 and 1996. Once NHI was implemented, the decline accelerated significantly, falling at 5.83% per year between 1996 and 1999. In contrast, there was little change in non-amenable causes (0.64% per year between 1981 and 1999). The effect of NHI was highest among the young and old, and lowest among those of working age, consistent with changes in the pattern of coverage. NHI was associated with substantial reductions in deaths from circulatory disorders and, for men, infections, whilst an earlier upward trend in female cancer deaths was reversed.


CONCLUSIONS
NHI was associated in a reduction in deaths considered amenable to health care; particularly among those age groups least likely to have been insured previously.
Lee
Yue-Chune
YC
Division of Health Policy Research and Development, Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan.
Huang
Yu-Tung
YT
Tsai
Yi-Wen
YW
Huang
Shiuh-Ming
SM
Kuo
Ken N
KN
McKee
Martin
M
Nolte
Ellen
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009313:National Health Programs; D019982:Organizational Case Studies; D012042:Registries; D012044:Regression Analysis; D013624:Taiwan / Q000453:epidemiology; D019472:Universal Health Insurance; D055815:Young Adult