Inherited from the early Laborer's Insurance, Government Employee’s Insurance and Farmer’s Insurance, Taiwan has implemented the National Health Insurance (NHI) since 1995. The NHI in Taiwan is a single payer, compulsory social insurance. The coverage rate has approached near 100% of the population in Taiwan recently since the inmates and military are also included.
Most (93.2%) of the health care facilities in Taiwan are contracted with NHI system, that amounts to 20620 hospitals and health care providers. In additional to these, there are also nearly 6000 pharmacies, over 500 home-nursing care institutions, 200 psychiatric community rehabilitation centers, 15 midwife clinics, 217 medical laboratories, 11 physical therapy clinics, nine medical radiology institutions, two occupational therapy clinics and one respiratory care clinic are also contracted (Source: National Health Insurance Annual Report 2015-2016).
The co-payments under NHI are very low (NT$ 50~450 for an outpatient visit, or up to NT$200 for a prescription, or 5%~30% for an episode of inpatient care); while the scopes of the benefit package of NHI are very wide: inpatient and ambulatory care, dental services, traditional Chinese medicine therapies, child delivery services, physical rehabilitation, home care, and chronic mental illness care, etc. These care include general diagnoses and treatment, medical consultations and operations, and related expenses such as examinations, laboratory tests, anesthesia, prescription medications, supplies, nursing care, hospital rooms, and certain OTC drugs. (Source: National Health Insurance Annual Report 2015-2016).
Geographic location of health care claims will be broadly classified into 6 regions in Taiwan. Salary range, which serves as the basis for enrollees’ premium calculation, can serve as a proxy indicator for socioeconomic status. Unlike many health insurance claims data in North America, over-the-counter medications are reimbursed and captured in NHI. Bundled payment according to the diagnosis-related group system only apply in limited number of disease conditions, therefore detailed drug use information during hospitalization is also available. An added advantage of the NHI data source is the low membership turnover rate, which is particularly important for long-term follow-up study.
The information system was carefully designed to facilitate the efficiency and validity of the claims information. The health insurance IC card, which was introduced in 2004, has built up a model for the adaptation of technology to facilitate the information exchange. In recent years, the National Health Insurance Administration (NHIA) has made a lot of efforts to ensure the quality and the speed of the claims records, as well as the confidentiality and privacy of the patient information.
As Dr. Ann W. Hsing incisively summarized in her article in JAMA Internal Medicine 2015, “the large and longitudinal nature of the [NHI claims] data permits a wide range of study design.” Indeed, many good research has been conducted and reported with the benefit of longitudinal health data for over a decade.
Here are some selected publications based on the large linked electronic healthcare databases in Taiwan.