The Influences of Taiwan's National Health Insurance on Women's Utilization Patterns of Prenatal Care in Taiwan

Abstract

Rationale: The public health system was the major vehicle for delivering prenatal care in Taiwan before 1995, when Taiwan's national health insurance (NHI) program started. Since the launch of the NHI program, Taiwan's NHI system has been playing the major role of delivering prenatal care. As the NHI may reduce the monetary and the traveling costs for seeking prenatal care, it is usually hypothesized that the NHI has positive influences on women's use of prenatal care. Nonetheless, there has been a lack of research exploring whether reduction of monetary and traveling costs for seeking prenatal care is totally beneficial to utilization of prenatal care. Our study aimed to furnish knowledge in this regard. Objectives: The objective of this paper was to assess the influences of Taiwan's National Health Insurance program (NHI) on Taiwanese women's utilization patterns of prenatal care. Methodology: We used several indicators to reflect the utilization patterns of prenatal care. Firstly, there were two binary variables indicating whether a woman followed her physician's instruction to have regular prenatal care visits, and used any ultrasound screening. We also adopted an ordinal variable to reflect the level of the convenience of transportation for using prenatal care, and a 3-point nominal variable to show the type of health care facility for receiving prenatal care. Lastly, we used a binary variable to signal a woman's behavior of switching health care facilities for prenatal care. Data for this study were from a Taiwanese family survey that collected information on Taiwanese women's child-bearing experiences. As the data could provide information with longitudinal nature and on women's health insurance status over time, we were able to examine the influences of the NHI by a difference-in-differences method. Results: Our results show that Taiwan's NHI has not had a substantial effect on advancing regular utilization of prenatal care and convenience in transportation for using prenatal care. In contrast, the NHI appears to increase the likelihood of seeking prenatal care in hospitals instead of clinics, and might induce the behavior of changing health care facilities for prenatal care during pregnancy. Conclusions: Because the utilization level had already been quite high before the launch of the NHI, the marginal effect of the NHI on the utilization level thus tends to be negligible. On the other hand, because most pregnant women could seek free prenatal care only from public health stations in the pre-NHI period, the NHI is expected to have a substantial effect on expanding the choice set of health care facilities for women. These arguments may partially explain the lack of a substantial NHI effect on increasing utilization of prenatal care, and the NHI effect on increasing the likelihood of seeking prenatal care from hospitals. Nonetheless, this phenomenon may also reflect that Taiwan's NHI has yet to address the issue of how to keep in the NHI scheme the merits of the pre-NHI system of providing prenatal care, and further advance the delivery of prenatal care of good quality.