National health insurance and life satisfaction in late life: longitudinal findings from a natural experiment in Taiwan

Abstract

To determine whether the availability of National Health Insurance (NHI) is associated with a longitudinal increase in life satisfaction among older Taiwanese adults. This study used data from the Taiwan Longitudinal Study on Aging, a nationally representative sample (n = 3778) of older adults aged 60 and above. Participants were interviewed prior to the establishment of NHI and on multiple occasions thereafter over the next 18 years. Growth curve models were employed to estimate the NHI effects on life satisfaction across various pre-NHI insurance groups over time while taking concurrent medical care utilization and health status into consideration. While somewhat complex and explained in detail herein, multivariate analyses found a significant increase in life satisfaction among older Taiwanese adults over the 12-year period since the establishment of NHI. Further, while the pre-NHI uninsured had a significantly lower level of life satisfaction than the pre-NHI insured government employees (β = -1.78, P < 0.05), even after controlling for concurrent medical care utilization and health status, the difference in life satisfaction was significantly reduced by NHI over time. NHI reduces the barriers to medical care utilization and improves life satisfaction among older Taiwanese adults, particularly for individuals who were uninsured prior to NHI.