The distribution of net benefits under the National Health Insurance programme in Taiwan.

Abstract:

:The redistributive effects of a social insurance programme are determined by how the programme is paid for-who pays and how much do they pay?-and how the benefits are distributed. As a result, the redistributive effects of a social health insurance programme should be evaluated on the basis of its net benefit-the difference between benefits and payment. Among the rich body of empirical analysis on equity in health care financing, however, most studies have relied on partial analysis, assessing equity by source of financing while ignoring the benefit side, or looking at equity in benefits but ignoring the funding side. Either approach risks misleading findings. In this study, therefore, the primary objective was to assess the distribution of net benefits across income groups under Taiwan's National Health Insurance (NHI) programme. This study observed a nationally representative sample of 74 012 NHI enrolees from 1996 to 2000. The unique NHI databases in Taiwan provide comprehensive enrolment and utilization information, and allowed linkage to each enrolee's income tax files. In addition to crude estimates, two-part models and ordinary least-square models were used to adjust inpatient and outpatient benefits for health care needs (age, sex, major disease status and physical disability). After adjusting for health care needs, the distribution of net benefits showed an apparent pro-poor pattern, with the lowest income group receiving the highest net benefits (NT$3353) and the top income group receiving the lowest net benefits (-NT$3072) in 1996. Although a clear pro-poor pattern was observed among those enrolees who paid wage-based premiums, this vertically equitable pattern was less evident among the enrolees who paid fixed premiums. Overall, a trend of increasing net benefits was observed in all income groups between 1996 and 2000, and all the NHI enrolees can be considered better off over time. In addition to contributing to the limited literature on equity in net benefits, the study provides an important policy reference to developing countries with large underground economies and relatively small populations of regular wage-earners as it indicates that using fixed premiums as a major financing scheme may pose a serious equity concern and policy challenge.

journal_name

Health Policy Plan

authors

Huang N,Yip W,Chou YJ,Wang PJ

doi

10.1093/heapol/czl037

subject

Has Abstract

pub_date

2007-01-01 00:00:00

pages

49-59

issue

1

eissn

0268-1080

issn

1460-2237

pii

czl037

journal_volume

22

pub_type

杂志文章
  • From favours to entitlements: community voice and action and health service quality in Zambia.

    abstract::Social accountability is increasingly invoked as a way of improving health services. This article presents a theory-driven qualitative study of the context, mechanisms and outcomes of a social accountability program, Citizen Voice and Action (CVA), implemented by World Vision (WV) in Zambia. Primary data were collecte...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czx024

    authors: Schaaf M,Topp SM,Ngulube M

    更新日期:2017-07-01 00:00:00

  • Provider payment in community-based health insurance schemes in developing countries: a systematic review.

    abstract:OBJECTIVES:Community-based health insurance (CBI) is a common mechanism to generate financial resources for health care in developing countries. We review for the first time provider payment methods used in CBI in developing countries and their impact on CBI performance. METHODS:We conducted a systematic review of the...

    journal_title:Health policy and planning

    pub_type: 杂志文章,评审

    doi:10.1093/heapol/czs034

    authors: Robyn PJ,Sauerborn R,Bärnighausen T

    更新日期:2013-03-01 00:00:00

  • Evidence on access to medicines for chronic diseases from household surveys in five low- and middle-income countries.

    abstract::The 2011 United Nations (UN) General Assembly Political Declaration on Prevention and Control of Non-Communicable Diseases (NCDs) brought NCDs to the global health agenda. Essential medicines are central to treating chronic diseases such as hypertension and diabetes. Our study aimed to quantify access to essential med...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czu107

    authors: Vialle-Valentin CE,Serumaga B,Wagner AK,Ross-Degnan D

    更新日期:2015-10-01 00:00:00

  • AIDS and international security in the United Nations System.

    abstract::Two assumptions underpin much of the literature that has examined the links between HIV/AIDS and security: (1) that HIV/AIDS is now firmly established as an international security issue; and (2) that Resolution 1308, adopted by the UN Security Council in July 2000, was the decisive moment in the securitization process...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czq051

    authors: Rushton S

    更新日期:2010-11-01 00:00:00

  • Distributional impact of the Malawian Essential Health Package.

    abstract::In low- and middle-income countries (LMICs), making the best use of scarce resources is essential to achieving universal health coverage. The design of health benefits packages creates the opportunity to select interventions on the basis of explicit objectives. Distributional cost-effectiveness analysis (DCEA) provide...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czaa015

    authors: Arnold M,Nkhoma D,Griffin S

    更新日期:2020-07-01 00:00:00

  • Whose policy is it anyway? International and national influences on health policy development in Uganda.

    abstract::As national resources for health decline, so dependence on international resources to finance the capital and recurrent costs is increasing. This dependence, combined with an increasing emphasis on policy-based, as opposed to project-based, lending and grant-making has been accompanied by greater involvement of intern...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/10.2.122

    authors: Okuonzi SA,Macrae J

    更新日期:1995-06-01 00:00:00

  • National Health Accounts development: lessons from Thailand.

    abstract::National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns; policy instruments to re-orientate the pattern can then be further introduced. The National ...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/14.4.342

    authors: Tangcharoensathien V,Laixuthai A,Vasavit J,Tantigate NA,Prajuabmoh-Ruffolo W,Vimolkit D,Lertiendumrong J

    更新日期:1999-12-01 00:00:00

  • Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial protection.

    abstract::This article assesses whether social franchising of tuberculosis (TB) services in Myanmar has succeeded in providing quality treatment while ensuring equity in access and financial protection for poor patients. Newly diagnosed TB patients receiving treatment from private general practitioners (GPs) belonging to the fr...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czm007

    authors: Lönnroth K,Aung T,Maung W,Kluge H,Uplekar M

    更新日期:2007-05-01 00:00:00

  • Treatment as insurance: HIV antiretroviral therapy offers financial risk protection in Malawi.

    abstract::Many countries have expanded insurance programmes in an effort to achieve universal health coverage (UHC). We assess a complementary path toward financial risk protection: increased access to technologies that improve health and reduce the risk of large health expenditures. Malawi has provided free HIV treatment since...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czaa023

    authors: Dickerson S,Baranov V,Bor J,Barofsky J

    更新日期:2020-07-01 00:00:00

  • Removing user fees for facility-based delivery services: a difference-in-differences evaluation from ten sub-Saharan African countries.

    abstract:BACKGROUND:Several countries in sub-Saharan Africa have recently adopted policies that remove user fees for facility-based delivery services. There is little rigorous evidence of the impact of these policies on utilization of delivery services and no evaluations have examined effects on neonatal mortality rates (NMR). ...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czu027

    authors: McKinnon B,Harper S,Kaufman JS,Bergevin Y

    更新日期:2015-05-01 00:00:00

  • From the field side of the binoculars: a different view on global public health surveillance.

    abstract::It is generally assumed by the donor community that the targeted funding of global, regional or cross-border surveillance programmes is an efficient way to support resource-poor countries in developing their own national public health surveillance infrastructure, to encourage national authorities to share outbreak int...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czl035

    authors: Calain P

    更新日期:2007-01-01 00:00:00

  • When 'solutions of yesterday become problems of today': crisis-ridden decision making in a complex adaptive system (CAS)--the Additional Duty Hours Allowance in Ghana.

    abstract::Implementation of policies (decisions) in the health sector is sometimes defeated by the system's response to the policy itself. This can lead to counter-intuitive, unanticipated, or more modest effects than expected by those who designed the policy. The health sector fits the characteristics of complex adaptive syste...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czs083

    authors: Agyepong IA,Kodua A,Adjei S,Adam T

    更新日期:2012-10-01 00:00:00

  • Scaling-up essential neuropsychiatric services in Ethiopia: a cost-effectiveness analysis.

    abstract:INTRODUCTION:There is an immense need for scaling-up neuropsychiatric care in low-income countries. Contextualized cost-effectiveness analyses (CEAs) provide relevant information for local policies. The aim of this study is to perform a contextualized CEA of neuropsychiatric interventions in Ethiopia and to illustrate ...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czv093

    authors: Strand KB,Chisholm D,Fekadu A,Johansson KA

    更新日期:2016-05-01 00:00:00

  • User fees and drug pricing policies: a study at Harare Central Hospital, Zimbabwe.

    abstract::In 1991, Zimbabwe introduced cost recovery measures as part of its programme of economic reforms, following a course taken by many developing countries. The system of user fees in public health care, aimed to 'protect and support the vulnerable groups' by exemption or incremental fees based on 4 income brackets. Drugs...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/10.3.319

    authors: Chisadza E,Maponga CC,Nazerali H

    更新日期:1995-09-01 00:00:00

  • Using cost-effectiveness analysis to evaluate targeting strategies: the case of vitamin A supplementation.

    abstract::Given the demonstrated efficacy of vitamin A supplements in reducing childhood mortality, health officials now have to decide whether it would be efficient to target the supplements to high risk children. Decisions about targeting are complex because they depend on a number of factors; the degree of clustering of prev...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/12.1.29

    authors: Loevinsohn BP,Sutter RW,Costales MO

    更新日期:1997-03-01 00:00:00

  • Collaboratively reframing mental health for integration of HIV care in Ethiopia.

    abstract:BACKGROUND:Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. METHOD:We describe a model for integrating complex specialty care wit...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czu058

    authors: Wissow LS,Tegegn T,Asheber K,McNabb M,Weldegebreal T,Jerene D,Ruff A

    更新日期:2015-07-01 00:00:00

  • Do academic knowledge brokers exist? Using social network analysis to explore academic research-to-policy networks from six schools of public health in Kenya.

    abstract::The potential for academic research institutions to facilitate knowledge exchange and influence evidence-informed decision-making has been gaining ground. Schools of public health (SPHs) may play a key knowledge brokering role-serving as agencies of and for development. Understanding academic-policymaker networks can ...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czv107

    authors: Jessani NS,Boulay MG,Bennett SC

    更新日期:2016-06-01 00:00:00

  • Determinants of patient choice of medical provider: a case study in rural China.

    abstract::This study examines the factors that influence patient choice of medical provider in the three-tier health care system in rural China: village health posts, township health centres, and county (and higher level) hospitals. The model is estimated using a multinomial logit approach applied to a sample of 1877 cases of o...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/13.3.311

    authors: Yip WC,Wang H,Liu Y

    更新日期:1998-09-01 00:00:00

  • Health policy-making in central and eastern Europe: lessons from the inaction on injuries?

    abstract::The burden of disease due to injuries has elicited virtually no public health response in the countries of central and eastern Europe, even though injuries have long been a much greater problem in the east of Europe than in the west, with children especially affected. This paper seeks to identify factors that have inh...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/15.3.263

    authors: McKee M,Zwi A,Koupilova I,Sethi D,Leon D

    更新日期:2000-09-01 00:00:00

  • "This body does not want free medicines": South African consumer perceptions of drug quality.

    abstract::OBJECTIVES Like many other developing countries, South Africa provides free medicines through its public health care facilities. Recent policies encourage generic substitution in the private sector. This study explored South African consumer perceptions of drug quality and whether these perceptions influenced how peop...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czp039

    authors: Patel A,Gauld R,Norris P,Rades T

    更新日期:2010-01-01 00:00:00

  • The complex association of health insurance and maternal health services in the context of a premium exemption for pregnant women: a case study in Northern Ghana.

    abstract:BACKGROUND:Health insurance premium exemptions for pregnant women are a strategy to increase coverage of maternal health services in sub-Saharan countries. We examine health insurance registration among pregnant women before or after the introduction of a premium exemption, and test whether registration increases utili...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czt086

    authors: Frimpong JA,Helleringer S,Awoonor-Williams JK,Aguilar T,Phillips JF,Yeji F

    更新日期:2014-12-01 00:00:00

  • Managing the health care market in developing countries: prospects and problems.

    abstract::There is increasing interest in the prospects for managed market reforms in developing countries, stimulated by current reforms and policy debates in developed countries, and by perceptions of widespread public sector inefficiency in many countries. This review examines the prospects for such reforms in a developing c...

    journal_title:Health policy and planning

    pub_type: 杂志文章,评审

    doi:10.1093/heapol/9.3.237

    authors: Broomberg J

    更新日期:1994-09-01 00:00:00

  • Insured yet vulnerable: out-of-pocket payments and India's poor.

    abstract::Protecting households from high out-of-pocket (OOP) payments for health care is an important health system goal. High OOP payments can push households into poverty and make them vulnerable to catastrophic health expenditures. This study, based in India, aims to: (a) estimate OOP payments for health and related impover...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czr029

    authors: Shahrawat R,Rao KD

    更新日期:2012-05-01 00:00:00

  • Review of corruption in the health sector: theory, methods and interventions.

    abstract::There is increasing interest among health policymakers, planners and donors in how corruption affects health care access and outcomes, and what can be done to combat corruption in the health sector. Efforts to explain the risk of abuse of entrusted power for private gain have examined the links between corruption and ...

    journal_title:Health policy and planning

    pub_type: 杂志文章,评审

    doi:10.1093/heapol/czm048

    authors: Vian T

    更新日期:2008-03-01 00:00:00

  • Measuring family planning quality and its link with contraceptive use in public facilities in Burkina Faso, Ethiopia, Kenya and Uganda.

    abstract::The individual impacts of several components of family planning service quality on contraceptive use have been studied, but the influence of a composite measure synthesizing these components has not been often investigated. We (1) develop a composite score for family planning service quality based on health facility d...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czy058

    authors: Fruhauf T,Zimmerman L,Kibira SPS,Makumbi F,Gichangi P,Shiferaw S,Seme A,Guiella G,Tsui A

    更新日期:2018-09-01 00:00:00

  • Review of quality assessment tools for family planning programmes in low- and middle-income countries.

    abstract::Measuring and tracking the quality of healthcare is a critical part of improving service delivery, clinic efficiency and health outcomes. However, no standardized or widely accepted tool exists to assess the quality of clinic-based family planning services in low- and middle-income countries. The objective of this lit...

    journal_title:Health policy and planning

    pub_type: 杂志文章,评审

    doi:10.1093/heapol/czw123

    authors: Sprockett A

    更新日期:2017-03-01 00:00:00

  • Is equity being sacrificed? Willingness and ability to pay for schistosomiasis control in China.

    abstract::Decentralization of the health care system in China has led to an increasing need for income generation at all operational levels, both for curative services and for public health programmes. In general, people have accepted the costs of curative services, although the impact of charges on health-seeking behaviour has...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/16.3.292

    authors: Yu D,Manderson L,Yuan L,Wei W,He H,Chen Y

    更新日期:2001-09-01 00:00:00

  • Budget line items for immunization in 33 African countries.

    abstract::When seeking to ensure financial sustainability of a health programme, existence of a line item in the Ministry of Health (MOH) budget is often seen as an essential, first step. We used immunization as a reference point for cross-country comparison of budgeting methods in Sub-Saharan African countries. Study objective...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czaa040

    authors: Griffiths UK,Asman J,Adjagba A,Yo M,Oguta JO,Cho C

    更新日期:2020-08-01 00:00:00

  • Donor funding for health reform in Africa: is non-project assistance the right prescription?

    abstract::During the past 10 years, donors have recognized the need for major reforms to achieve sustainable development. Using non-project assistance they have attempted to leverage reforms by offering financing conditioned on the enactment of reform. The experience of USAID's health reform programmes in Niger and Nigeria sugg...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/9.4.371

    authors: Foltz AM

    更新日期:1994-12-01 00:00:00

  • Bypassing districts? Implications of sector-wide approaches and decentralization for integrating gender equity in Uganda and Kenya.

    abstract::While the concept of gender mainstreaming has gained acceptance among many national and international development organizations, many obstacles are faced in translating the concept into tangible improvements in the health and well-being of women and men. This paper presents two qualitative case studies, one from Kenya...

    journal_title:Health policy and planning

    pub_type: 杂志文章

    doi:10.1093/heapol/czi017

    authors: Elsey H,Kilonzo N,Tolhurst R,Molyneux C

    更新日期:2005-05-01 00:00:00