THE EFFECT OF UNIVERSAL HEALTH-INSURANCE ON HEALTH-CARE UTILIZATION IN TAIWAN - RESULTS FROM A NATURAL EXPERIMENT

Context.-The government of Taiwan introduced universal health insuranc e to cover all citizens in 1995. This national health insurance progra m was proposed to assure the accessibility to health care at reasonabl e cost. Evaluation of the consequences, including health care utilizat ion and expenditure, is crucial for policy adjustment. Objectives.-To evaluate the effect of Taiwan's national health insurance on health ca re utilization. Design.-Cohort survey conducted before and after the i mplementation of the national health insurance program. Participants.- A total of 1021 randomly selected Taiwanese adults. Main Outcome Measu res.-Physician visits in the 2 weeks prior to the survey and hospital admissions and emergency department visits in the immediate past year. Results.-After the introduction of universal health insurance, the ne wly insured consumed more than twice the amount of outpatient physicia n 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, bringin g them to the same amount of health care contacts as the previously in sured group. The newly insured also experienced an insignificant incre ase in emergency department visits. In contrast, the previously insure d group had a small but statistically significant increase in outpatie nt visits (0.48 vs 0.59, P<.05) and insignificant changes in hospital admissions and emergency department visits. Conclusion. The universal health insurance removed some barriers to health care for those newly insured. The co-payment 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 insura nce.