title: Redistributive effects of the National Health Insurance on physicians in Taiwan: a natural experiment time series study.
abstract: BACKGROUND
  Previous studies have evaluated the effects of various health manpower policies but did not include full consideration of the effect of universal health insurance on physician re-distribution. This study examines the effects of implementing National Health Insurance (NHI) on the problem of geographic mal-distribution of health providers in Taiwan.
  
  
  METHODS
  Data on health providers and population between 1971 and 2001 are obtained from relevant governmental publications in Taiwan. Gini coefficients derived from the Lorenz curve are used under a spline regression model to examine the impact of the NHI on the geographic distribution of health providers.
  
  
  RESULTS
  The geographic distribution equality of the three key health providers has improved significantly after the implementation of NHI program. After accounting for the influences of other confounding factors, Gini coefficients of the three key providers have a net reduction of 1.248% for dentists, 0.365% for western medicine physicians, and 0.311% for Chinese medicine physicians. Overall, the absolute values of the three key providers' Gini coefficients also become close to one another.
  
  
  CONCLUSIONS
  This study found that NHI's offering universal health coverage to all citizens and with proper financial incentives have resulted in more equal geographic distributions among the key health care providers in Taiwan.
authors: Department of Health Care Management, National Taipei University ofNursing and Health Sciences, Taipei, Taiwan.
authors: Chiang-Hsing
authors: CH
authors: Yang
authors: Yu-Tung A
authors: YT
authors: Huang
authors: Ya-Seng A
authors: YS
authors: Hsueh
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D010820:Physicians / Q000600:supply & distribution*; D012044:Regression Analysis; D013624:Taiwan; D019472:Universal Health Insurance; D000078329:Workforce
references: CMAJ. 1993 Apr 15;148(8):1301-7
references: 8462051
references: JAMA. 1999 Jan 20;281(3):255-60
references: 9918481
references: Tohoku J Exp Med. 2009 Apr;217(4):299-305
references: 19346735
references: Soc Sci Med. 1994 May;38(9):1243-56
references: 8016689
references: Aust N Z J Public Health. 1999 Apr;23(2):126-30
references: 10330724
references: Health Econ. 2000 Oct;9(7):571-4
references: 11103921
references: Health Aff (Millwood). 2003 May-Jun;22(3):61-76
references: 12757273
references: Health Policy Plan. 1996 Dec;11(4):406-17
references: 10164197
references: Health Policy. 1997 Mar;39(3):225-39
references: 10165463
references: Ophthalmic Epidemiol. 2009 Nov-Dec;16(6):354-61
references: 19995200
references: J Rural Health. 2007 Spring;23(2):183-7
references: 17397377
references: Soc Sci Med. 2010 Dec;71(11):2014-9
references: 20970901
references: N Engl J Med. 1993 Apr 1;328(13):934-9
references: 8446141
references: Am J Public Health. 1986 Jun;76(6):638-42
references: 3706590
references: Am J Epidemiol. 2002 Feb 15;155(4):323-31
references: 11836196
references: Health Care Anal. 2006 Sep;14(3):157-68
references: 17214251
references: BMJ. 1999 Oct 30;319(7218):1162-5
references: 10541504
references: Health Policy Plan. 2007 May;22(3):156-66
references: 17434870
references: Soc Sci Med. 1995 Aug;41(4):475-82
references: 7481941
references: Health Serv Res. 2004 Dec;39(6 Pt 2):2135-53
references: 15544648
references: Lancet. 1992 Dec 5;340(8832):1391-3
references: 1360099
references: Pediatrics. 2001 Mar;107(3):E31
references: 11230612
references: Health Policy. 2004 May;68(2):223-32
references: 15063021
references: JAMA. 1996 Sep 4;276(9):683-8
references: 8769545
references: Pediatrics. 1997 Aug;100(2 Pt 1):172-9
references: 9240795