Cheng S H, Chiang T L
Graduate Institute of Public Health and Center for Health Policy Research, College of Public Health, National Taiwan University, Taipei.
JAMA. 1997 Jul 9;278(2):89-93. doi: 10.1001/jama.278.2.89.
The government of Taiwan introduced universal health insurance to cover all citizens in 1995. This national health insurance program was proposed to assure the accessibility to health care at reasonable cost. Evaluation of the consequences, including health care utilization and expenditure, is crucial for policy adjustment.
To evaluate the effect of Taiwan's national health insurance on health care utilization.
Cohort survey conducted before and after the implementation of the national health insurance program.
A total of 1021 randomly selected Taiwanese adults.
Physician visits in the 2 weeks prior to the survey and hospital admissions and emergency department visits in the immediate past year.
After the introduction of universal health insurance, the newly insured consumed more than twice the amount of outpatient physician visits (0.21 vs 0.48, P<.05) and hospital admissions (0.04 vs 0.11, P<.05) than before universal health insurance was implemented, bringing them to the same amount of health care contacts as the previously insured group. The newly insured also experienced an insignificant increase in emergency department visits. In contrast, the previously insured group had a small but statistically significant increase in outpatient visits (0.48 vs 0.59, P<.05) and insignificant changes in hospital admissions and emergency department visits.
The universal health insurance removed some barriers to health care for those newly insured. The copayment design in the insurance scheme seemed to have an insignificant effect on curbing medical care utilization. Taiwanese health policy analysts should seriously consider the growth of health care expenditures since the implementation of universal health insurance.
台湾地区政府于1995年推行全民健康保险，覆盖所有公民。这项国民健康保险计划旨在确保民众能够以合理成本获得医疗服务。评估其后果，包括医疗服务利用情况和支出，对于政策调整至关重要。
评估台湾地区国民健康保险对医疗服务利用的影响。
在国民健康保险计划实施前后进行队列调查。
共随机选取1021名台湾成年人。
调查前2周内的门诊就诊次数，以及过去一年中的住院次数和急诊就诊次数。
推行全民健康保险后，新参保者的门诊就诊次数（0.21对0.48，P<0.05）和住院次数（0.04对0.11，P<0.05）比实施全民健康保险前增加了两倍多，与之前参保组的医疗接触次数相同。新参保者的急诊就诊次数也有不显著增加。相比之下，之前参保组的门诊就诊次数有小幅但具有统计学意义的增加（0.48对0.59，P<0.05），住院次数和急诊就诊次数变化不显著。
全民健康保险消除了新参保者获得医疗服务的一些障碍。保险计划中的共付设计似乎对抑制医疗服务利用影响不大。台湾地区的卫生政策分析人员应认真考虑全民健康保险实施以来医疗费用的增长情况。
