title: National health insurance and life satisfaction in late life: longitudinal findings from a natural experiment in Taiwan.
abstract: BACKGROUND
  To determine whether the availability of National Health Insurance (NHI) is associated with a longitudinal increase in life satisfaction among older Taiwanese adults.
  
  
  METHODS
  This study used data from the Taiwan Longitudinal Study on Aging, a nationally representative sample (n = 3778) of older adults aged 60 and above. Participants were interviewed prior to the establishment of NHI and on multiple occasions thereafter over the next 18 years. Growth curve models were employed to estimate the NHI effects on life satisfaction across various pre-NHI insurance groups over time while taking concurrent medical care utilization and health status into consideration.
  
  
  RESULTS
  While somewhat complex and explained in detail herein, multivariate analyses found a significant increase in life satisfaction among older Taiwanese adults over the 12-year period since the establishment of NHI. Further, while the pre-NHI uninsured had a significantly lower level of life satisfaction than the pre-NHI insured government employees (β = -1.78, P < 0.05), even after controlling for concurrent medical care utilization and health status, the difference in life satisfaction was significantly reduced by NHI over time.
  
  
  CONCLUSIONS
  NHI reduces the barriers to medical care utilization and improves life satisfaction among older Taiwanese adults, particularly for individuals who were uninsured prior to NHI.
authors.affiliation: Institute of Health and Welfare Policy and Research Center for Health and Welfare Policy, College of Medicine, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., 112, Taipei, Taiwan, ROC.
authors.forename: Chi
authors.initials: C
authors.lastname: Chiao
authors.affiliation: Communication Department, College of Arts and Communication, University of Wisconsin-Whitewater, Whitewater, WI, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Ksobiech
authors.affiliation: Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
authors.forename: Chia-Yi
authors.initials: CY
authors.lastname: Wei
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D010549:Personal Satisfaction; D013624:Taiwan
keywords: life satisfaction; longitudinal analysis; national health insurance program; older adults