A 10-year experience with universal health insurance in Taiwan

Measuring changes in health and health disparity

Chi Pang Wen, Shan Pou Tsai, Wen Shen Isabella Chung

Research output: Contribution to journalArticle

Abstract

Background: Universal national health insurance, financed jointly by payroll taxes, subsidies, and individual premiums, commenced in Taiwan in 1995. Coverage expanded from 57% of the population (before the introduction of national health insurance) to 98%. Objective: To assess the role of national health insurance in improving life expectancy and reducing health disparities in Taiwan. Design: A before-and-after comparison of the decade before the introduction of national health insurance (1982-1984 to 1992-1994) with the decade after (1992-1994 to 2002-2004). Setting: Taiwan. Patients: All townships (n = 358) in Taiwan were ranked according to overall mortality rates before the introduction of national health insurance and then ranked into 10 health class groups in descending order of health (groups 1 [healthiest] to 10 [least healthy]). Measurements: Health improvement (change in life expectancy after the introduction of national health insurance) and health disparity (reduction in the difference in life expectancy between the highest- and lowest-ranked health class groups). Results: After the introduction of national health insurance, life expectancy increased more in health class groups that had higher mortality rates before the introduction of national health insurance and health disparity narrowed, reversing an earlier trend toward widening disparity. The major contributors to the reduction in disparity were relatively larger reductions in death from cardiovascular diseases, ill-defined conditions, infectious diseases, and accidents in the lower-ranked health class groups. However, death from cancer increased more in the lower-ranked health class groups. Utilization of medical services increased, whereas cost remained at 5% to 6% of the gross domestic product. The per capita average annual number of visits to the physician's office was 14. Limitation: The interpretation of comparisons before and after the introduction of national health insurance assumes that the changes were entirely due to the effect of national health insurance rather than secular trends. Conclusion: Life expectancy after the introduction of national health insurance improved more for lower-ranked health classes, resulting in narrowed health disparity. The magnitude of the reduced disparity was small compared with the size of the remaining gaps. Relying on universal insurance alone to eliminate health disparity does not seem realistic. To further reduce health disparity, universal insurance programs should incorporate primary prevention, focusing on lifestyle risk reductions.

Original languageEnglish (US)
Pages (from-to)258-267
Number of pages10
JournalAnnals of Internal Medicine
Volume148
Issue number4
StatePublished - Feb 19 2008
Externally publishedYes

Fingerprint

Health Insurance
Taiwan
National Health Programs
Health
Life Expectancy
Insurance
Gross Domestic Product
Physicians' Offices
Mortality
Taxes
Risk Reduction Behavior
Primary Prevention
Accidents
Communicable Diseases
Cardiovascular Diseases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

A 10-year experience with universal health insurance in Taiwan : Measuring changes in health and health disparity. / Wen, Chi Pang; Tsai, Shan Pou; Chung, Wen Shen Isabella.

In: Annals of Internal Medicine, Vol. 148, No. 4, 19.02.2008, p. 258-267.

Research output: Contribution to journalArticle

Wen, Chi Pang ; Tsai, Shan Pou ; Chung, Wen Shen Isabella. / A 10-year experience with universal health insurance in Taiwan : Measuring changes in health and health disparity. In: Annals of Internal Medicine. 2008 ; Vol. 148, No. 4. pp. 258-267.
@article{a5cfc6b2727942099961391ffa0da8fc,
title = "A 10-year experience with universal health insurance in Taiwan: Measuring changes in health and health disparity",
abstract = "Background: Universal national health insurance, financed jointly by payroll taxes, subsidies, and individual premiums, commenced in Taiwan in 1995. Coverage expanded from 57{\%} of the population (before the introduction of national health insurance) to 98{\%}. Objective: To assess the role of national health insurance in improving life expectancy and reducing health disparities in Taiwan. Design: A before-and-after comparison of the decade before the introduction of national health insurance (1982-1984 to 1992-1994) with the decade after (1992-1994 to 2002-2004). Setting: Taiwan. Patients: All townships (n = 358) in Taiwan were ranked according to overall mortality rates before the introduction of national health insurance and then ranked into 10 health class groups in descending order of health (groups 1 [healthiest] to 10 [least healthy]). Measurements: Health improvement (change in life expectancy after the introduction of national health insurance) and health disparity (reduction in the difference in life expectancy between the highest- and lowest-ranked health class groups). Results: After the introduction of national health insurance, life expectancy increased more in health class groups that had higher mortality rates before the introduction of national health insurance and health disparity narrowed, reversing an earlier trend toward widening disparity. The major contributors to the reduction in disparity were relatively larger reductions in death from cardiovascular diseases, ill-defined conditions, infectious diseases, and accidents in the lower-ranked health class groups. However, death from cancer increased more in the lower-ranked health class groups. Utilization of medical services increased, whereas cost remained at 5{\%} to 6{\%} of the gross domestic product. The per capita average annual number of visits to the physician's office was 14. Limitation: The interpretation of comparisons before and after the introduction of national health insurance assumes that the changes were entirely due to the effect of national health insurance rather than secular trends. Conclusion: Life expectancy after the introduction of national health insurance improved more for lower-ranked health classes, resulting in narrowed health disparity. The magnitude of the reduced disparity was small compared with the size of the remaining gaps. Relying on universal insurance alone to eliminate health disparity does not seem realistic. To further reduce health disparity, universal insurance programs should incorporate primary prevention, focusing on lifestyle risk reductions.",
author = "Wen, {Chi Pang} and Tsai, {Shan Pou} and Chung, {Wen Shen Isabella}",
year = "2008",
month = "2",
day = "19",
language = "English (US)",
volume = "148",
pages = "258--267",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "4",

}

TY - JOUR

T1 - A 10-year experience with universal health insurance in Taiwan

T2 - Measuring changes in health and health disparity

AU - Wen, Chi Pang

AU - Tsai, Shan Pou

AU - Chung, Wen Shen Isabella

PY - 2008/2/19

Y1 - 2008/2/19

N2 - Background: Universal national health insurance, financed jointly by payroll taxes, subsidies, and individual premiums, commenced in Taiwan in 1995. Coverage expanded from 57% of the population (before the introduction of national health insurance) to 98%. Objective: To assess the role of national health insurance in improving life expectancy and reducing health disparities in Taiwan. Design: A before-and-after comparison of the decade before the introduction of national health insurance (1982-1984 to 1992-1994) with the decade after (1992-1994 to 2002-2004). Setting: Taiwan. Patients: All townships (n = 358) in Taiwan were ranked according to overall mortality rates before the introduction of national health insurance and then ranked into 10 health class groups in descending order of health (groups 1 [healthiest] to 10 [least healthy]). Measurements: Health improvement (change in life expectancy after the introduction of national health insurance) and health disparity (reduction in the difference in life expectancy between the highest- and lowest-ranked health class groups). Results: After the introduction of national health insurance, life expectancy increased more in health class groups that had higher mortality rates before the introduction of national health insurance and health disparity narrowed, reversing an earlier trend toward widening disparity. The major contributors to the reduction in disparity were relatively larger reductions in death from cardiovascular diseases, ill-defined conditions, infectious diseases, and accidents in the lower-ranked health class groups. However, death from cancer increased more in the lower-ranked health class groups. Utilization of medical services increased, whereas cost remained at 5% to 6% of the gross domestic product. The per capita average annual number of visits to the physician's office was 14. Limitation: The interpretation of comparisons before and after the introduction of national health insurance assumes that the changes were entirely due to the effect of national health insurance rather than secular trends. Conclusion: Life expectancy after the introduction of national health insurance improved more for lower-ranked health classes, resulting in narrowed health disparity. The magnitude of the reduced disparity was small compared with the size of the remaining gaps. Relying on universal insurance alone to eliminate health disparity does not seem realistic. To further reduce health disparity, universal insurance programs should incorporate primary prevention, focusing on lifestyle risk reductions.

AB - Background: Universal national health insurance, financed jointly by payroll taxes, subsidies, and individual premiums, commenced in Taiwan in 1995. Coverage expanded from 57% of the population (before the introduction of national health insurance) to 98%. Objective: To assess the role of national health insurance in improving life expectancy and reducing health disparities in Taiwan. Design: A before-and-after comparison of the decade before the introduction of national health insurance (1982-1984 to 1992-1994) with the decade after (1992-1994 to 2002-2004). Setting: Taiwan. Patients: All townships (n = 358) in Taiwan were ranked according to overall mortality rates before the introduction of national health insurance and then ranked into 10 health class groups in descending order of health (groups 1 [healthiest] to 10 [least healthy]). Measurements: Health improvement (change in life expectancy after the introduction of national health insurance) and health disparity (reduction in the difference in life expectancy between the highest- and lowest-ranked health class groups). Results: After the introduction of national health insurance, life expectancy increased more in health class groups that had higher mortality rates before the introduction of national health insurance and health disparity narrowed, reversing an earlier trend toward widening disparity. The major contributors to the reduction in disparity were relatively larger reductions in death from cardiovascular diseases, ill-defined conditions, infectious diseases, and accidents in the lower-ranked health class groups. However, death from cancer increased more in the lower-ranked health class groups. Utilization of medical services increased, whereas cost remained at 5% to 6% of the gross domestic product. The per capita average annual number of visits to the physician's office was 14. Limitation: The interpretation of comparisons before and after the introduction of national health insurance assumes that the changes were entirely due to the effect of national health insurance rather than secular trends. Conclusion: Life expectancy after the introduction of national health insurance improved more for lower-ranked health classes, resulting in narrowed health disparity. The magnitude of the reduced disparity was small compared with the size of the remaining gaps. Relying on universal insurance alone to eliminate health disparity does not seem realistic. To further reduce health disparity, universal insurance programs should incorporate primary prevention, focusing on lifestyle risk reductions.

UR - http://www.scopus.com/inward/record.url?scp=40049109862&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=40049109862&partnerID=8YFLogxK

M3 - Article

VL - 148

SP - 258

EP - 267

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 4

ER -