Abstract
Based on the 1978 Alma-Ata Declaration, the key to achieving health for all is primary health care, and many countries have established various comprehensive health care systems. Because of the financial toll of a public health care system, government-sponsored public health insurance is not universally accepted. This study used Taiwan as the backdrop to understand why many health clinics have chosen not to accept the National Health Insurance (NHI), despite it covering 99.93% of the country’s population. The clinics’ operational details were garnered from the datasets of Taiwan’s open government data platforms and checked against the list of contracting clinics within the NHI. Of 10,907 Western medicine primary care clinics in 2016, as many as 9846 (90.3%) clinics had signed contracts with the NHI. The remaining 1061 noncontracting clinics were distributed in urban (94.5%, n = 1003), suburban (4.9%, n = 52), and rural/remote areas (0.6%, n = 6). The NHI did not have contracts with 183 plastic surgery, 88 internal medicine, and 85 surgery clinics. In conclusion, nearly one-tenth of clinics practiced independently of the NHI in Taiwan. Their reasons for declining the contract and practices for delivering their services deserve further studies.
Highlights
The International Conference on Primary Health Care, known as the Declaration ofAlma-Ata, expressed the need to protect and promote health for all people worldwide.It declared that health is a socioeconomic issue and is a basic human right [1]
In addition to serving people within the Republic of China (ROC), after many amendments to the law, the National Health Insurance (NHI) has gradually included non-nationals who have been registered in Taiwan for six months to be eligible for public health insurance
A total of to clinicswith not an enrolled in proportion the NHI were located
Summary
The International Conference on Primary Health Care, known as the Declaration ofAlma-Ata, expressed the need to protect and promote health for all people worldwide.It declared that health is a socioeconomic issue and is a basic human right [1]. The International Conference on Primary Health Care, known as the Declaration of. Alma-Ata, expressed the need to protect and promote health for all people worldwide. It declared that health is a socioeconomic issue and is a basic human right [1]. Many international governments have applied different types of health care systems in their countries to achieve this goal. Countries such as the United Kingdom, Australia, Denmark, Finland, Greece, Iceland, Ireland, Italy, Latvia, New Zealand, Norway, Portugal, Spain, and Sweden have implemented the National Health Service (NHS), which offers widespread coverage and is financed by general tax revenue. The public’s access rate, hospitalization rate, and average length of stay are lower than those of NHI countries, but the public has higher waiting periods, less choice of care, less efficient institutions, and lower
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