Chi Pang Wen, MD, DrPH; Shan Pou Tsai, PhD; Wen-Shen Isabella Chung, MSc
Wen CP, Tsai SP, Chung WI. A 10-Year Experience with Universal Health Insurance in Taiwan: Measuring Changes in Health and Health Disparity. Ann Intern Med. 2008;148:258-267. doi: 10.7326/0003-4819-148-4-200802190-00004
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Published: Ann Intern Med. 2008;148(4):258-267.
The effects of implementing universal national health insurance are largely unknown.
Taiwan imiplemented national health insurance in 1995. In the decade before national insurance, differences in life expectancy between the healthiest and least healthy regions were increasing. Afterward, they decreased, but the gaps in life expectancy between the healthiest and least healthy regions remained large. Utilization and expenditures on health care increased, whereas the percentage of gross domestic product spent on health care remained at 5% to 6%.
The authors could not prove that universal national health insurance alone reduced health disparities.
Universal national health insurance may reduce health disparities, but only by a small amount.
Appendix Table 1.
*Increase in life expectancy during the period before NHI (from 1982–1984 to 1992–1994). †Increase in life expectancy during the period after NHI (from 1992–1994 to 2002–2004).
Pre-NHI was 1982–1984 to 1992–1994, and post-NHI was 1992–1994 to 2002–2004. Error bars represent 95% CIs.
HCG = health class group. Results are based on a modified cause–deletion life-table method, which assumes independence for each cause of death. Not all possible causes of death are included. Bars extending below the horizontal axis indicate that deaths from those causes contributed to reduced life expectancy, whereas bars extending above the horizontal axis contributed to improved life expectancy.
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