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Open Access Highly Accessed Research article

The impact of universal National Health Insurance on population health: the experience of Taiwan

Yue-Chune Lee1, Yu-Tung Huang2, Yi-Wen Tsai3, Shiuh-Ming Huang4, Ken N Kuo3*, Martin McKee5 and Ellen Nolte6

Author Affiliations

1 Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taipei, Taiwan

2 Department of Gerontological Care and Management, Chang Gung Institute of Technology, Tao-Yuan, Taiwan

3 Division of Health Policy Research and Development, Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan

4 Office of Statistics, Department of Health, Taipei, Taiwan

5 European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK

6 Director Health and Healthcare, RAND Europe, Cambridge, UK

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BMC Health Services Research 2010, 10:225  doi:10.1186/1472-6963-10-225

Published: 4 August 2010

Abstract

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.