Initial effects of the National Health Insurance program in Taiwan on access to health care

Objectives. (1) To identify the factors that influence health services utilization before and after the implementation of the National Health Insurance program and (2) To examine the impacts of the National Health Insurance program on the improvement of equitable access.;Methods. This study utilizes data from two population-based surveys conducted 35 months before and 16 months after the implementation of the National Health Insurance program. Both surveys utilized multi-stage sampling methods and achieved large, representative samples with response rates of 90.8% (N = 21,267) in the first survey and 85% (N = 5,284) in the second. The study focuses on the survey data pertinent to utilization of ambulatory visits to Western physicians and Chinese physicians, as well as hospital admissions and emergency room visits. Andersen's Behavioral Model of Health Services Use provides the framework for the analyses.;Principal Findings. Analysis results suggest that once the insurance barrier was removed, different income tiers show that a more equitable access has been achieved regarding utilization of emergency room visits. People living in central cities have significantly greater use (1.5 times the rate) of ambulatory Chinese physician services than individuals in rural areas.;In terms of predictors of various healthcare services, need factors such as perceived health status and evaluated chronic symptom severity are the dominant predictors of health care utilization in both time periods. Among predisposing factors, gender and health beliefs are the predictors of ambulatory care, while marital status (or living with a partner or not) and occupational status play some role in affecting hospital use. Among the enabling factors, the waiting time to be seen by doctors influences ambulatory western physician visits and emergency room visits, while having a regular source of care only affects ambulatory western physician visits.