Effects of National Health Insurance on household out-of-pocket expenditure structure

Yu Chun Ku, Yiing Jenq Chou, Miaw Chwen Lee, Christy Pu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Achieving universal health insurance coverage is a major objective for many countries. Taiwan implemented its National Health Insurance (NHI) program with universal coverage in 1995. This study investigates whether the NHI program affects the level and structures of out-of-pocket (OOP) health expenditures. We used data from the Taiwan Survey of Family Income and Expenditure released by the Directorate-General of Budget, Accounting and Statistics. We identified a case and a control group and then employed coarsened exact matching to match the two groups using several available variables. We then conducted a difference-in-difference analysis and determined that there was a statistically significant negative effect on OOP expenditure that was attributable to NHI (a reduction of 2.11 percentage points in total household expenditure). The largest reductions were found in health care services (−1.63%) and pharmaceuticals (−0.45%). We found a statistically significant positive effect on purchases of private insurance related to health care, which was attributable to NHI (an increase of 0.96 percentage points in household budget share). In addition, we discovered that the NHI program had a greater impact on households of a lower socioeconomic status compared with higher socioeconomic status households. The structure of OOP payments in the post-NHI period remained similar to that of the pre-NHI period in the full sample but varied slightly depending on the educational level of the head of the household.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalSocial Science and Medicine
StatePublished - Feb 2019


  • Difference-in-difference
  • Medical spending
  • National Health Insurance
  • Out-of-pocket


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