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The impact of National Health Insurance on birth outcomes: A natural experiment in Taiwan

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  • Chou, Shin-Yi
  • Grossman, Michael
  • Liu, Jin-Tan

Abstract

We estimate the impacts of the introduction of National Health Insurance in Taiwan in March 1995 on infant survival. Prior to NHI, government workers (the control group) possessed health insurance policies with comprehensive coverage for births and infant medical care services. Private sector industrial workers and farmers (the treatment groups) lacked this coverage. All households received coverage in 1995. Since stringent requirements for reporting births introduced in 1994 produced artificial upward trends in early infant deaths, we focus on postneonatal mortality. The introduction of NHI led to reductions in this rate for infants born in farm households but not for infants born in private sector households. For the former group, the rate fell by between 0.3 and 0.6 deaths per thousand survivors or by between 8 and 16%. A large decline of between 3.4 and 6.8 deaths occurred for pre-term infants—a drop of between 20 and 41%.

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  • Chou, Shin-Yi & Grossman, Michael & Liu, Jin-Tan, 2014. "The impact of National Health Insurance on birth outcomes: A natural experiment in Taiwan," Journal of Development Economics, Elsevier, vol. 111(C), pages 75-91.
    • Handle: RePEc:eee:deveco:v:111:y:2014:i:c:p:75-91
    DOI: 10.1016/j.jdeveco.2014.08.004
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    3. Halla, Martin & Liu, Chia-Lun & Liu, Jin-Tan, 2019. "The Effect of Superstition on Health: Evidence from the Taiwanese Ghost Month," IZA Discussion Papers 12066, Institute of Labor Economics (IZA).
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    5. Chen, Yuyu & Jin, Ginger Zhe, 2012. "Does health insurance coverage lead to better health and educational outcomes? Evidence from rural China," Journal of Health Economics, Elsevier, vol. 31(1), pages 1-14.
    6. Emmanuelle Lavaine & Matthew Neidell, 2017. "Energy Production and Health Externalities: Evidence from Oil Refinery Strikes in France," Journal of the Association of Environmental and Resource Economists, University of Chicago Press, vol. 4(2), pages 447-477.
    7. Bhalotra, Sonia & Fernandez, Manuel, 2021. "The Right to Health and the Health Effects of Denials," The Warwick Economics Research Paper Series (TWERPS) 1376, University of Warwick, Department of Economics.
    8. Rana Ejaz Ali Khan & Muhammad Ali Raza, 2016. "Utilization of prenatal-care in India: an evidence from IDHS," Journal of Social and Economic Development, Springer;Institute for Social and Economic Change, vol. 18(1), pages 175-201, October.
    9. Chou, Shin-Yi & Grossman, Michael & Liu, Jin-Tan, 2014. "The impact of National Health Insurance on birth outcomes: A natural experiment in Taiwan," Journal of Development Economics, Elsevier, vol. 111(C), pages 75-91.
    10. Hope Corman & Dhaval Dave & Nancy E. Reichman, 2018. "Evolution of the Infant Health Production Function," Southern Economic Journal, John Wiley & Sons, vol. 85(1), pages 6-47, July.
    11. Avi Dor & William Encinosa & Kathleen Carey, 2016. "Do Good Reports Mean Higher Prices? The Impact of Hospital Compare Ratings on Cardiac Pricing," NBER Working Papers 22858, National Bureau of Economic Research, Inc.
    12. Lin Lin & Xianhua Zai, 2022. "The role of supply responses in public insurance expansion: evidence from China's New Cooperative Medical Scheme," MPIDR Working Papers WP-2022-025, Max Planck Institute for Demographic Research, Rostock, Germany.
    13. Hua Chen & Jianing Xing & Xiaoxu Yang & Kai Zhan, 2021. "Heterogeneous Effects of Health Insurance on Rural Children’s Health in China: A Causal Machine Learning Approach," IJERPH, MDPI, vol. 18(18), pages 1-14, September.
    14. Glenn W. Harrison & Jia Min Ng, 2019. "Behavioral insurance and economic theory: A literature review," Risk Management and Insurance Review, American Risk and Insurance Association, vol. 22(2), pages 133-182, July.
    15. Noemi Kreif & Andrew Mirelman & Rodrigo Moreno-Serra & Taufik Hidayat, & Karla DiazOrdaz & Marc Suhrcke, 2020. "Who benefits from health insurance? Uncovering heterogeneous policy impacts using causal machine learning," Working Papers 173cherp, Centre for Health Economics, University of York.
    16. Lingguo Cheng & Hong Liu & Ye Zhang & Ke Shen & Yi Zeng, 2015. "The Impact of Health Insurance on Health Outcomes and Spending of the Elderly: Evidence from China's New Cooperative Medical Scheme," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 672-691, June.
    17. Supon Limwattananon & Sven Neelsen & Owen O'Donnell & Phusit Prakongsai & Viroj Tangcharoensathien & Eddy van Doorslaer, 2013. "Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand," Tinbergen Institute Discussion Papers 13-067/V, Tinbergen Institute.
    18. Lin, Lin & Zai, Xianhua, 2022. "The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme," GLO Discussion Paper Series 1180, Global Labor Organization (GLO).
    19. Monica Lambon-Quayefio & Nkechi S. Owoo, 2017. "Determinants and the impact of the National Health Insurance on neonatal mortality in Ghana," Health Economics Review, Springer, vol. 7(1), pages 1-16, December.
    20. Meng-Wen Tsou & Jin-Tan Liu & Kuang-Hsien Wang, 2014. "Impact of Low Birth Weight Child on Maternal Labour Force Participation: Evidence from Taiwan," Pacific Economic Review, Wiley Blackwell, vol. 19(4), pages 483-501, October.
    21. Huang, Xian & Wu, Bingxiao, 2020. "Impact of urban-rural health insurance integration on health care: Evidence from rural China," China Economic Review, Elsevier, vol. 64(C).
    22. Avi Dor & William Encinosa & Kathleen Carey, 2020. "Hospital performance standards and medical pricing: The impact of information disclosure in cardiac care," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 29(3), pages 492-515, July.
    23. Kondo, Ayako & Shigeoka, Hitoshi, 2013. "Effects of universal health insurance on health care utilization, and supply-side responses: Evidence from Japan," Journal of Public Economics, Elsevier, vol. 99(C), pages 1-23.
    24. Yu-Chen Kuo & Jia-Huey Lin, 2020. "Picking the lock: how universal healthcare programs influence entrepreneurial activities," Small Business Economics, Springer, vol. 54(1), pages 3-24, January.

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    More about this item

    Keywords

    Health insurance; Natural experiment; Birth outcomes;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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