Wen Chi Pang, Tsai Shan Pou, Chung Wen-Shen Isabella
Center for Health Policy Research and Development, National Health Research Institutes, Zhunan, Taiwan.
Ann Intern Med. 2008 Feb 19;148(4):258-67. doi: 10.7326/0003-4819-148-4-200802190-00004.
Universal national health insurance, financed jointly by payroll taxes, subsidies, and individual premiums, commenced in Taiwan in 1995. Coverage expanded from 57% of the population (before the introduction of national health insurance) to 98%.
To assess the role of national health insurance in improving life expectancy and reducing health disparities in Taiwan.
A before-and-after comparison of the decade before the introduction of national health insurance (1982-1984 to 1992-1994) with the decade after (1992-1994 to 2002-2004).
Taiwan.
All townships (n = 358) in Taiwan were ranked according to overall mortality rates before the introduction of national health insurance and then ranked into 10 health class groups in descending order of health (groups 1 [healthiest] to 10 [least healthy]).
Health improvement (change in life expectancy after the introduction of national health insurance) and health disparity (reduction in the difference in life expectancy between the highest- and lowest-ranked health class groups).
After the introduction of national health insurance, life expectancy increased more in health class groups that had higher mortality rates before the introduction of national health insurance and health disparity narrowed, reversing an earlier trend toward widening disparity. The major contributors to the reduction in disparity were relatively larger reductions in death from cardiovascular diseases, ill-defined conditions, infectious diseases, and accidents in the lower-ranked health class groups. However, death from cancer increased more in the lower-ranked health class groups. Utilization of medical services increased, whereas cost remained at 5% to 6% of the gross domestic product. The per capita average annual number of visits to the physician's office was 14.
The interpretation of comparisons before and after the introduction of national health insurance assumes that the changes were entirely due to the effect of national health insurance rather than secular trends.
Life expectancy after the introduction of national health insurance improved more for lower-ranked health classes, resulting in narrowed health disparity. The magnitude of the reduced disparity was small compared with the size of the remaining gaps. Relying on universal insurance alone to eliminate health disparity does not seem realistic. To further reduce health disparity, universal insurance programs should incorporate primary prevention, focusing on lifestyle risk reductions.
全民健康保险于1995年在台湾开始实施，由薪资税、补贴和个人保费共同资助。保险覆盖范围从全民健康保险实施前的57%扩大到了98%。
评估全民健康保险在提高台湾地区预期寿命和减少健康差距方面的作用。
对全民健康保险实施前的十年（1982 - 1984年至1992 - 1994年）和实施后的十年（1992 - 1994年至2002 - 2004年）进行前后对比。
台湾
台湾所有乡镇（n = 358）根据全民健康保险实施前的总体死亡率进行排名，然后按照健康程度从高到低分为10个健康等级组（1组[最健康]至10组[最不健康]）。
健康改善情况（全民健康保险实施后预期寿命的变化）和健康差距（最高和最低健康等级组之间预期寿命差异的缩小）。
全民健康保险实施后，在全民健康保险实施前死亡率较高的健康等级组中，预期寿命增长更多，健康差距缩小，扭转了此前差距扩大的趋势。差距缩小的主要原因是排名较低的健康等级组中心血管疾病、不明原因疾病、传染病和事故导致的死亡人数相对大幅减少。然而，排名较低的健康等级组中癌症导致的死亡人数增加得更多。医疗服务利用率提高，而成本仍占国内生产总值的5%至6%。人均每年看医生的次数为14次。
对全民健康保险实施前后对比的解读假设这些变化完全是由于全民健康保险的影响，而非长期趋势。
全民健康保险实施后，排名较低的健康等级组的预期寿命改善更大，从而缩小了健康差距。与剩余差距的规模相比，缩小的差距幅度较小。仅依靠全民保险来消除健康差距似乎并不现实。为了进一步减少健康差距，全民保险计划应纳入初级预防，重点是降低生活方式风险。
