National Health Insurance program and life satisfaction of the elderly

Abstract

Objectives: To ensure people's fundamental right to adequate medical care, universal health insurance is given a high priority in contemporary public policy. This article investigates the effects of the introduction of Taiwan's National Health Insurance (NHI) on life satisfaction within the elderly segment of the population.

Methods: A longitudinal data set including 610 males and 430 females aged 65 or above was constructed from the Survey of Health and Living Status of the Elderly in Taiwan. A difference-in-differences-in-differences model was employed and estimated by the random-effect regression method.

Results: The effects of NHI on life satisfaction are different by gender. Compared to the change in life satisfaction between the previously uninsured and insured elderly men, the introduction of NHI had a larger effect of 4.330 points on reducing the disparity in life satisfaction between previously uninsured and insured elderly women. Education, living arrangements, lifestyle, social activities, geographic location, and urbanization level are also important determinants for life satisfaction among the elderly.

Conclusions: Although NHI is designed to ensure equality for accessing health care, the implementation of NHI has also improved the subjective well-being of the elderly, with a larger improvement for the elderly women. The post-NHI disparity reductions in life satisfaction between the previously uninsured and insured are significantly greater among elderly women. Our analysis of Taiwan's experience should provide a valuable lesson to countries that are in the initial stages of proposing a universal health insurance program.

Keywords:

• universal health insurance
• life satisfaction
• elderly
• gender
• Taiwan

Acknowledgments

All the authors appreciate the Bureau of Health Promotion, Department of Health, and National Health Research Institutes in Taiwan for providing the data. The interpretation and conclusions contained here do not represent those of the Bureau of Health Promotion, Department of Health, or National Health Research Institutes.

Notes

Notes

1. For example, Chou and Staiger (2001) found that the introduction of NHI in Taiwan caused a 4% point decline in labor force participation among married women and a 6% point decline among married women from low-income households.

2. As pointed out by one anonymous reviewer, it may be more interesting to include the 1989, 1999, and 2003 data sets as well to understand the long-term effect of NHI for policy purposes. However, with a longer time period, many other contemporaneous things are likely to occur and confound the policy change effect (Duflo, 2002). As a result, we have followed most of the applications of the difference-in-differences (DiD) method using the years before and after the NHI implementation for empirical analysis.

3. The DiD method has been applied to examine the effects of the NHI implementation on labor force participation (Chou & Staiger, 2001) and household-savings decisions (Chou et al., 2003) in Taiwan.

4. We thank one anonymous reviewer for this suggestion. In the preliminary analysis, we estimated two separate DiD models for males and females. The reviewer suggested that we further take the gender difference into account, an accommodation that forms the DiDiD framework. More details of the DiDiD method can be found in Gruber (1994).

5. In 1993, the difference in life satisfaction between the continuing insured and new insured groups (the pool sample without gender subgroups) was 6.911 points. The NHI-caused 5.166% reduction of disparity in life satisfaction between the previously uninsured and insured elderly was calculated by 0.357/6.911.

6. Given that the difference in life satisfaction between elderly women in the continuing insured and new insured groups was 8.855 points prior to NHI; a 4.330 point effect is equivalent to a 48.899% (4.330/8.855) reduction of disparity in life satisfaction between the elderly women in the continuing insured and the new insured groups.