Chiao Chi, Ksobiech Kate, Wei Chia-Yi
Institute of Health and Welfare Policy and Research Center for Health and Welfare Policy, College of Medicine, National Yang-Ming University, No. 155, Sec. 2, Li-Nong St., 112, Taipei, Taiwan, ROC.
Communication Department, College of Arts and Communication, University of Wisconsin-Whitewater, Whitewater, WI, USA.
J Public Health (Oxf). 2014 Jun;36(2):308-16. doi: 10.1093/pubmed/fdt055. Epub 2013 Jun 3.
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.
确定国民健康保险（NHI）的可及性是否与台湾老年成年人生活满意度的纵向提升相关。
本研究使用了台湾老年纵向研究的数据，该研究是对60岁及以上老年人的全国代表性样本（n = 3778）。参与者在NHI建立之前接受了访谈，并在之后的18年中多次接受访谈。采用生长曲线模型来估计NHI对不同NHI前保险组随时间推移的生活满意度的影响，同时考虑到同期的医疗服务利用情况和健康状况。
虽然情况有些复杂并在此详细解释，但多变量分析发现，自NHI建立以来的12年期间，台湾老年成年人的生活满意度有显著提高。此外，虽然NHI前未参保者的生活满意度水平明显低于NHI前参保的政府雇员（β = -1.78，P < 0.05），但即使在控制了同期的医疗服务利用情况和健康状况之后，随着时间的推移，NHI使生活满意度的差异显著缩小。
NHI减少了医疗服务利用的障碍，提高了台湾老年成年人的生活满意度，特别是对于NHI之前未参保的个体。
