National Health Insurance Program (NHIP) of Taiwan: A pre & post policy analysis of the utilization of medical care by Taiwanese elderly with cardiovascular diseases

In 1995, Taiwan implemented a national health insurance program (NHI) to provide equitable, affordable, and universal health care coverage to all its citizens. Prior to this, 43% of the population was uninsured and 57% was covered by one of three major insurance programs. In this study, we examine the effect of NHI on the utilization of medical services (physician visits and medication use) for high blood pressure (HBP). We compare utilization before and after the introduction of NHI across three groups—those who were uninsured, covered by government insurance (GI), and covered by non-government insurance (NGI) prior to 1995. Analyses are based on data from the 1993 and 1999 waves of the Survey of Health and Living Status of the Middle-Aged and Elderly in Taiwan (1989-2003). The sample is restricted to persons age 70+ who have HBP. Multivariate logit regressions models are based on Andersen’s behavioral model of health services utilization. Results suggest that before NHI, insured respondents were more likely to visit a physician and use medications for their HBP compared to their uninsured counterparts. After NHI, these differentials are reduced, except that those with NGI remain more likely than those who were uninsured prior to NHI to visit a physician. The results provide support for the effectiveness of NHI in increasing utilization of health care and reducing the gap in utilization between the previously uninsured and insured. Implications of these results provide potential guidelines in formulating health care policies in managing and reducing the adverse effects of HBP. National Health Insurance and Treatment for High Blood Pressure among Older Taiwanese 3