You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 278 No. 2, July 9, 1997 TABLE OF CONTENTS
  JAMA
  •  Online Features
  Letter From Taipei
 This Article
 •References
 •Full text PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in JAMA
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

The Effect of Universal Health Insurance on Health Care Utilization in Taiwan

Results From a Natural Experiment

Cheng Shou-Hsia, PhD; Chiang Tung-Liang, ScD

JAMA. 1997;278(2):89-93.


Abstract

Context.
—The government of Taiwan introduced universal health insurance to cover all citizens in 1995. This national health insurance program was proposed to assure the accessibility to health care at reasonable cost. Evaluation of the consequences, including health care utilization and expenditure, is crucial for policy adjustment.

Objectives.
—To evaluate the effect of Taiwan's national health insurance on health care utilization.

Design.
—Cohort survey conducted before and after the implementation of the national health insurance program.

Participants.
—A total of 1021 randomly selected Taiwanese adults.

Main Outcome Measures.
—Physician visits in the 2 weeks prior to the survey and hospital admissions and emergency department visits in the immediate past year.

Results.
—After the introduction of universal health insurance, the newly insured consumed more than twice the amount of outpatient physician visits (0.21 vs 0.48, P<.05) and hospital admissions (0.04 vs 0.11, P<.05) than before universal health insurance was implemented, bringing them to the same amount of health care contacts as the previously insured group. The newly insured also experienced an insignificant increase in emergency department visits. In contrast, the previously insured group had a small but statistically significant increase in outpatient visits (0.48 vs 0.59, P<.05) and insignificant changes in hospital admissions and emergency department visits.

Conclusion.
—The universal health insurance removed some barriers to health care for those newly insured. The copayment design in the insurance scheme seemed to have an insignificant effect on curbing medical care utilization. Taiwanese health policy analysts should seriously consider the growth of health care expenditures since the implementation of universal health insurance.



Author Affiliations

From the Graduate Institute of Public Health and Center for Health Policy Research, College of Public Health, National Taiwan University, Taipel, Taiwan.


Footnotes

Edited by Annette Flanagin, RN, MA, Associate Senior Editor.

Reprints: Shou-Hsia Cheng, PhD, Institute of Public Health, National Taiwan University, Room 1515, No. 1, Section 1, Jen-Ai Rd, Taipei, Taiwan 100 (e-mail: shcheng@ntumc1.mc.ntu.edu.tw).



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Prescriptions of Chinese Herbal Medicines for Insomnia in Taiwan during 2002
Chen et al.
Evid Based Complement Alternat Med 2009;0:nep018v1-nep018.
ABSTRACT | FULL TEXT  

A 10-Year Experience with Universal Health Insurance in Taiwan: Measuring Changes in Health and Health Disparity
Wen et al.
ANN INTERN MED 2008;148:258-267.
ABSTRACT | FULL TEXT  

Prevalence and Risks of Chronic Airway Obstruction: A Population Cohort Study in Taiwan
Wang et al.
Chest 2007;131:705-710.
ABSTRACT | FULL TEXT  

Treatment outcomes in patients receiving conventional amphotericin B therapy: a prospective multicentre study in Taiwan
Chen et al.
J Antimicrob Chemother 2006;57:1181-1188.
ABSTRACT | FULL TEXT  

Quality Competition Among Hospitals: The Effects of Perceived Quality and Perceived Expensiveness on Health Care Consumers
Cheng et al.
American Journal of Medical Quality 2006;21:68-75.
ABSTRACT  

Arsenic ingestion and increased microvascular disease risk: observations from the south-western arseniasis-endemic area in Taiwan
Chiou et al.
Int J Epidemiol 2005;34:936-943.
ABSTRACT | FULL TEXT  

Decreased fecundity among male lead workers
Shiau et al.
Occup. Environ. Med. 2004;61:915-923.
ABSTRACT | FULL TEXT  

Physician performance information and consumer choice: a survey of subjects with the freedom to choose between doctors
Cheng and Song
Qual Saf Health Care 2004;13:98-101.
ABSTRACT | FULL TEXT  

Patient satisfaction with and recommendation of a hospital: effects of interpersonal and technical aspects of hospital care
CHENG et al.
Int J Qual Health Care 2003;15:345-355.
ABSTRACT | FULL TEXT  

Does Universal Health Insurance Make Health Care Unaffordable? Lessons From Taiwan
Lu and Hsiao
Health Aff (Millwood) 2003;22:77-88.
ABSTRACT | FULL TEXT  

National Health Insurance, Physician Financial Incentives, and Primary Cesarean Deliveries in Taiwan
Tsai and Hu
AJPH 2002;92:1514-1517.
ABSTRACT | FULL TEXT  

Inappropriate Use of Antibiotics and the Risk for Delayed Admission and Masked Diagnosis of Infectious Diseases: A Lesson From Taiwan
Liu et al.
Arch Intern Med 2001;161:2366-2370.
ABSTRACT | FULL TEXT  

Impact of Cognitive Status and Decline on Service and Support Utilization among Older Adults in Taiwan
Zimmer et al.
Research on Aging 2001;23:267-303.
ABSTRACT  

Moral Medicine and Universal Health Care
Emanuel
JAMA 1997;278:1494-1494.
ABSTRACT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1997 American Medical Association. All Rights Reserved.