The effect of universal health insurance on health care utilization in Taiwan. Results from a natural experiment

Cheng, Shou‐Hsia; Chiang, Tung‐Liang

doi:10.1001/jama.278.2.89

Cited by 249 publications

(169 citation statements)

References 10 publications

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“…First, improved access to medical care in Taiwan may have resulted in higher detection and diagnosis rates. 4,12,13 Taiwan's NHI is a government-sponsored NHI Program. At the end of 2003, more than 97% of Taiwan residents were enrolled and most (497%) of the hospital and clinics in Taiwan belong to the insurance programme.…”

Section: Discussionmentioning

confidence: 99%

Retinoblastoma in Taiwan: incidence and survival characteristics from 1979 to 2003

Chen

Lin

Hsu

et al. 2009

Eye

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Purpose To describe the incidence and survival rate of patients with retinoblastoma in Taiwan over a 25-year period, from 1979 to 2003. Methods Cases of retinoblastoma have been reported to the Taiwan National Cancer Registry (TNCR) since 1979. Retinoblastoma data from 1979 to 2003 were retrieved from the TNCR databank for analysis of both the incidence and survival rate. Trends in the incidence rate were estimated by calculating the annual percentage change (APC).Results From 1979 to 2003, a total of 380 patients (182 [47.9%] females) with retinoblastoma were identified. Of the 380 cases, 359 patients (94.5%) were diagnosed before 5 years of age. The average annual agestandardized incidence rate was 4.45 per million in children under 10 years of age and 8.58 per million in children under 5 years of age. There was a significant increasing trend in the incidence rate over the study period with an APC of 2.3% (P ¼ 0.035). Before the implementation of Taiwan's National Health Insurance (NHI) Program in 1995, the mean age at diagnosis was 4.8 ± 13.3 years and the 5-year survival rate was 74.7%. After implementation of the NIH Program, the mean age at diagnosis decreased to 1.6 ± 2.1 years (Po0.001) and the 5-year survival rate increased to 84.7% (P ¼ 0.063). Conclusions We report the first populationbased study on retinoblastoma in Taiwan. There was a significant increasing trend in the incidence rate from 1979 to 2003. Since the implementation of Taiwan's NHI, the mean diagnostic age decreased.

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Section: Discussionmentioning

confidence: 99%

Retinoblastoma in Taiwan: incidence and survival characteristics from 1979 to 2003

Chen

Lin

Hsu

et al. 2009

Eye

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“…Moreover, the Taiwan Cancer Registry is believed to be more complete especially in recent years, as medical-care access is no longer a problem since the implementation of the National Health Insurance Program. 32 The secular trends of cancer incidence and cancer risk differences among ethnic groups may provide researchers with clues for testing the aetiology of, and perhaps preventive methods for, specific malignancies. Comparative research on eye cancers in various races or geographic areas is often limited by low attack rates and rarity of large cancer registries.…”

Section: Discussionmentioning

confidence: 99%

Incidence of eye cancer in Taiwan: an 18-year review

Cheng

Hsu

2004

Eye

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Purpose To describe the incidence and histologic patterns of eye cancers in Chinese in Taiwan. Methods Beginning in 1979, cases of cancer in Taiwan were reported to the Taiwan National Cancer Registry. Information on all Chinese patients diagnosed with eye malignancies under the International Classification of Disease, Ninth Revision, site 190, was retrieved for analysis from the data bank of the Taiwan National Cancer Registry. Results In all, 733 cases with primary eye cancers were identified from 1979 to 1996, an 18-year period. The average annual agestandardized incidence of eye cancers was 2.46 per million population (2.57 for male and 2.33 for female). For cases less than 15 years of age, the most common eye malignancy was retinoblastoma (86.0%), followed by rhabdomyosarcoma (3.9%) and lymphoma (2.8%). For cases 15 years of age or older, the most common eye malignancy was melanoma (28.6%), followed by squamous cell sarcoma (21.0%) and lymphoma (20.8%). Conclusions The time trends of the incidence of eye cancers were relatively stable over the 18-year period in Taiwan. Retinobalstoma, melanoma, and lymphoma were the three most common eye cancers in this Chinese population.

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“…The copayment rate for patients is as low as 8-20%, with a fixed charge of $1.40 U.S. Thus, almost all the people, particularly those affected with chronic diseases, have been using the contracted health providers (Cheng and Chiang 1997). More than 96% of the population, in different age and gender groups, who were covered by National Health Insurance have used health services at least once through contracted health providers during 1999(DOH 2002.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of non-insulin-dependent diabetes mellitus and related vascular diseases in southwestern arseniasis-endemic and nonendemic areas in Taiwan.

Wang

Chiou

Chen

et al. 2003

Environ Health Perspect

138

111

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There is evidence indicating that ingestion of arsenic may predispose the development of diabetes mellitus in arsenic-endemic areas in Taiwan. However, the prevalence of diabetes and related vascular diseases in the entire southwestern arseniasis-endemic and nonendemic areas remains to be elucidated. We used the National Health Insurance Database for 1999-2000 to derive the prevalence of non-insulin-dependent diabetes and related vascular diseases by age and sex among residents in southwestern arseniasis-endemic and nonendemic areas in Taiwan. The study included 66,667 residents living in endemic areas and 639,667 in nonendemic areas, all ≥ 25 years of age. The status of diabetes and vascular diseases was ascertained through disease diagnosis and treatment prescription included in the reimbursement claims of clinics and hospitals. The prevalence of non-insulin-dependent diabetes, age-and gender-adjusted to the general population in Taiwan, was 7.5% (95% confidence interval, 7.4-7.7%) in the arseniasis-endemic areas and 3.5% (3.5-3.6%) in the nonendemic areas. Among both diabetics and nondiabetics, higher prevalence of microvascular and macrovascular diseases was observed in arseniasis-endemic than in the nonendemic areas. Age-and gender-adjusted prevalence of microvascular disease in endemic and nonendemic areas was 20.0% and 6.0%, respectively, for diabetics, and 8.6% and 1.0%, respectively, for nondiabetics. The corresponding prevalence of macrovascular disease was 25.3% and 13.7% for diabetics, and 12.3% and 5.5% for nondiabetics. Arsenic has been suggested to increase the risk of non-insulin-dependent diabetes mellitus and its related micro-and macrovascular diseases.

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The effect of universal health insurance on health care utilization in Taiwan. Results from a natural experiment

Cited by 249 publications

References 10 publications

Retinoblastoma in Taiwan: incidence and survival characteristics from 1979 to 2003

Retinoblastoma in Taiwan: incidence and survival characteristics from 1979 to 2003

Incidence of eye cancer in Taiwan: an 18-year review

Prevalence of non-insulin-dependent diabetes mellitus and related vascular diseases in southwestern arseniasis-endemic and nonendemic areas in Taiwan.

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