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The effects of Taiwan's National Health Insurance on access and health status of the elderly

  • Likwang Chen

    (Center for Health Policy Research and Development, National Health Research Institutes, Taiwan)

  • Winnie Yip

    (School of Public Health, Harvard University, Cambridge, MA, USA)

  • Ming-Cheng Chang

    (Graduate Institute of Healthcare Administration, Taichung Healthcare and Management University, Taiwan)

  • Hui-Sheng Lin

    (Department of Public Health, Chung Shan Medical University, Taiwan)

  • Shyh-Dye Lee

    (Graduate Institute of Long-Term Care, National Taipei College of Nursing, National Taiwan University Hospital, Bei Hu Branch, Taiwan)

  • Ya-Ling Chiu

    (Center for Health Policy Research and Development, National Health Research Institutes, Taiwan)

  • Yu-Hsuan Lin

    (Center for Population and Health Survey Research, Bureau of Health Promotion, Department of Health, Taiwan)

The primary objective of this paper is to evaluate the impact of Taiwan's National Health Insurance program (NHI), established in 1995, on improving elderly access to care and health status. Further, we estimate the extent to which NHI reduces gaps in access and health across income groups. Using data from a longitudinal survey, we adopt a difference-in-difference methodology to estimate the causal effect of Taiwan's NHI. Our results show that Taiwan's NHI has significantly increased utilization of both outpatient and inpatient care among the elderly, and such effects were more salient for people in the low- or middle-income groups. Our findings also reveal that although Taiwan's NHI greatly increased the utilization of both outpatient and inpatient services, this increased utilization of health services did not reduce mortality or lead to better self-perceived general health status for Taiwanese elderly. Measures more sensitive than mortality and self-perceived general health may be necessary for discerning the health effects of NHI. Alternatively, the lack of NHI effects on health may reflect other quality and efficiency problems inherent in the system not yet addressed by NHI. Copyright © 2006 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.1160
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Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 16 (2007)
Issue (Month): 3 ()
Pages: 223-242

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Handle: RePEc:wly:hlthec:v:16:y:2007:i:3:p:223-242
Contact details of provider: Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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  1. Hanratty, Maria J, 1996. "Canadian National Health Insurance and Infant Health," American Economic Review, American Economic Association, vol. 86(1), pages 276-84, March.
  2. Janet Currie & Jonathan Gruber, 1997. "The Technology of Birth: Health Insurance, Medical Interventions, and Infant Health," NBER Working Papers 5985, National Bureau of Economic Research, Inc.
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  5. Currie, Janet & Gruber, Jonathan, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, MIT Press, vol. 111(2), pages 431-66, May.
  6. Winnie Yip & Karen Eggleston, 2001. "Provider payment reform in China: the case of hospital reimbursement in Hainan province," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 325-339.
  7. Cheng, Shou-Hsia & Chiang, Tung-Liang, 1998. "Disparity of medical care utilization among different health insurance schemes in Taiwan," Social Science & Medicine, Elsevier, vol. 47(5), pages 613-620, September.
  8. Goldman D. P. & Bhattacharya J. & McCaffrey D. F. & Duan N. & Leibowitz A. A. & Joyce G. F. & Morton S. C., 2001. "Effect of Insurance on Mortality in an HIV-Positive Population in Care," Journal of the American Statistical Association, American Statistical Association, vol. 96, pages 883-894, September.
  9. Pannarunothai, Supasit & Mills, Anne, 1997. "The poor pay more: Health-related inequality in Thailand," Social Science & Medicine, Elsevier, vol. 44(12), pages 1781-1790, June.
  10. Hugh R. Waters, 1999. "Measuring the impact of health insurance with a correction for selection bias-a case study of Ecuador," Health Economics, John Wiley & Sons, Ltd., vol. 8(5), pages 473-483.
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