The impact of public policy on Taiwan's health care system after implementing national health insurance

Implementation of National Health Insurance (NHI) in 1995 represented a significant milestone in the Taiwan healthcare scenario. The purpose of this research is to explore the views of physician providers on how NHI policies relate with healthcare utilization, quality, and cost of health care in Taiwan. The primary objective was to evaluate the early impacts of certain policy initiatives under the NHI program in terms of consumer and provider attitudes. In the light of the study findings, policy recommendations are made for improvement. Since providers play a major role in health care, this research aims to develop a framework for qualitative research and data analysis on provider behaviors.; Data for this research came from the 2000 Health Services Market Stakeholder Survey conducted by the Chung-Hua Institution for Economic Research (CIER). Because Taiwan's health delivery system is almost a closed type, the population for sampling included all service providers of hospitals and clinics in Taiwan area. Constructs were identified through theory, literature review, qualitative methods (such as interviews) and expert review. To investigate the effects of NHI policies as perceived by physicians, bivariate and multivariate methods were used to study the association of sixteen NHI policy reforms with four distinct constructs: change in number of visits, improvement of internal cost control, improvement in quality of care, and acceptability of policy.; The research findings provide insights into providers' views about the differences in the medical practices adopted by different organizations. Physicians' viewpoints drive their practice behaviors and levels of resource utilization. This research throws light on how the type of physician organization, and physician payment methods affect the utilization of health care services and effectiveness of health policy reforms. Hospital characteristics expected to influence health services utilization, hospital ownership and type of hospital (size), are also taken into account.; The findings strongly suggest that future health care reform efforts in Taiwan should focus on provider behavior. Supply-side policies should be the preferred instruments for cost control. In designing optimal contract policies, the Bureau of NHI should use a combination of economic incentives and monitoring to better influence provider practices.