Household out-of-pocket medical expenditures and national health insurance in Taiwan: income and regional inequality

Tu-Bin Chu,Tsai-Ching Liu,Wen-Ta Chiu,Yi-Wen Tsai,Chin-Shyan Chen

doi:10.1186/1472-6963-5-60

Tu-Bin Chu, Tsai-Ching Liu + Show 3 more

Open Access

https://doi.org/10.1186/1472-6963-5-60

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Abstract

BackgroundUnequal geographical distribution of medical care resources and insufficient healthcare coverage have been two long-standing problems with Taiwan's public health system. The implementation of National Health Insurance (NHI) attempted to mitigate the inequality in health care use. This study examines the degree to which Taiwan's National Health Insurance (NHI) has reduced out-of-pocket medical expenditures in households in different regions and varying levels of income.MethodsData used in this study were drawn from the 1994 and 1996 Surveys of Family Income and Expenditure. We pooled the data from 1994 and 1996 and included a year dummy variable (NHI), equal to 1 if the household data came from 1996 in order to assess the impact of NHI on household out-of-pocket medical care expenditures shortly after its implementation in 1995.ResultsAn individual who was older, female, married, unemployed, better educated, richer, head of a larger family household, or living in the central and eastern areas was more likely to have greater household out-of-pocket medical expenditures. NHI was found to have effectively reduced household out-of-pocket medical expenditures by 23.08%, particularly for more affluent households. With the implementation of NHI, lower and middle income quintiles had smaller decreases in out-of-pocket medical expenditure. NHI was also found to have reduced household out-of-pocket medical expenditures more for households in eastern Taiwan.ConclusionAlthough NHI was established to create free medical care for all, further effort is needed to reduce the medical costs for certain disadvantaged groups, particularly the poor and aborigines, if equality is to be achieved.

Highlights

Unequal geographical distribution of medical care resources and insufficient healthcare coverage have been two long-standing problems with Taiwan's public health system
The poor pay a larger share of their income for out-of-pocket medical expenditures than the rich in most countries; only a few, including Colombia and Vietnam, have implemented healthcare reforms capable of remedying regressivity and reducing medical costs for the poor [9,10]
After the implementation of National Health Insurance (NHI), total household out-ofpocket medical expenditures dropped from NT$23,046 in 1994 to NT$17,726 in 1996 (23.08%) (Table 3)

Summary

Introduction

Unequal geographical distribution of medical care resources and insufficient healthcare coverage have been two long-standing problems with Taiwan's public health system. The implementation of National Health Insurance (NHI) attempted to mitigate the inequality in health care use. This study examines the degree to which Taiwan's National Health Insurance (NHI) has reduced out-of-pocket medical expenditures in households in different regions and varying levels of income. Since a national insurance program should spread risks over large population groups and reduce medical costs for all patients, the poor, it is important to understand how the health care reform (NHI) reduces and to what extent it reduces out-of-pocket expenditures for medical care. The poor pay a larger share of their income for out-of-pocket medical expenditures than the rich in most countries; only a few, including Colombia and Vietnam, have implemented healthcare reforms capable of remedying regressivity and reducing medical costs for the poor [9,10]. No studies have assessed the impact of Taiwan's NHI on out-of-pocket medical expenditures

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