Age Structural Transitions and Copayment Policy Effectiveness: Evidence from Taiwan's National Health Insurance System.

Ya-Ling Lin,Wen-Yi Chen,Shwn-Huey Shieh

doi:10.3390/ijerph17124183

Abstract

Background: Population ageing is a worldwide phenomenon that could influence health policy effectiveness. This research explores the impact of age structural transitions on copayment policy responses under Taiwan’s National Health Insurance (NHI) system. Methods: The time-varying parameter vector autoregressive model was applied to create two measures of the copayment policy effectiveness, and multiple linear regression models were used to verify the nonlinear effect of age structural transitions on copayment policy responses. Results: Our results show that copayment policy effectiveness (in terms of the negative response of medical center outpatient visits to upward adjustments in copayment) is positively correlated with the proportions of the population in two older age groups (aged 55–64 and ≥ 65) and children (age < 15), but negatively correlated with the proportion of the population that makes up most of the workforce (aged 15‒54). These tendencies of age distribution, which influence the responses of medical center outpatient visits to copayment policy changes, predict that copayment policy may have a greater influence on medical center outpatient utilization in an ageing society. Conclusions: Policymakers should be concerned about the adverse effects of copayment adjustments on the elderly, such as an increasing financial burden and the effect of pricing some elderly patients out of Taiwan’s NHI system.

Highlights

Since our time-varying parameter vector autoregressive model is capable of dealing with the changes in outpatient care utilization related to the changes in copayment policies made during our study period, the results generated in this study can provide insight into the influence of population ageing on the healthcare system
The null hypothesis of parameter stability in the vector autoregressive system was soundly rejected, and these results validated the use of the time-varying parameter vector autoregressive model to evaluate the responses of medical center outpatient visits to the changes in copayment per outpatient visit for various types of healthcare providers
Since the proportions of the population making up the bulk of the workforce have significantly positive effects on the accumulative maximum and maximum responses of medical center outpatient visits to upward adjustments in copayment, one may expect that copayment policy would be less effective when these major working populations expand

Summary

Introduction

Taiwan’s National Health Insurance (NHI) system is a government-implemented social insurance program providing universal healthcare coverage (based on pay-as-you-go principles) to all residents in Taiwan. This system has encountered tremendous financial difficulties over the past two decades due to the nature of publicly financed healthcare systems [1]. Results: Our results show that copayment policy effectiveness (in terms of the negative response of medical center outpatient visits to upward adjustments in copayment) is positively correlated with the proportions of the population in two older age groups (aged 55–64 and ≥ 65) and children (age < 15), but negatively correlated with the proportion of the population that makes up most of the workforce (aged 15–54). Conclusions: Policymakers should be concerned about the adverse effects of copayment adjustments on the elderly, such as an increasing financial burden and the effect of pricing some elderly patients out of Taiwan’s NHI system

Methods

Results

Discussion

Conclusion