實施全民健康保險對兒童及青少年健康的影響──臺灣經驗

Effects of the Universal Health Insurance Program on the Health Outcomes of Children and Adolescents - The Experience of Taiwan

目的：臺灣在1995 年實施全民健康保險制度前，有超過85％的兒童及青少年並沒有健康保險的保障。然而全民健保實施對兒童及青少年健康的影響評估資訊卻相形較少。方法：本研究以時間趨勢分析法，比較1981 至2005 年間兒童及青少年可避免死亡疾病死亡率的變動趨勢，尤其關注於實施全民健康保險後是否有顯著改變。研究資料分別取自衛生福利部死因資料統計及內政部戶籍人口資料檔，逐年計算年齡及性別標準化特定死因死亡率，以進行統計分析。結果：研究結果顯示在實施全民健康保險後，兒童及青少年的可避免死亡疾病死亡率有顯著下降，且其下降的幅度大於非可避免死亡疾病的死亡率。可避免死亡疾病死亡率在1981 至2005 年間共分為兩個轉折點、三段趨勢，從1981 年到1987 年平均年死亡率改變百分比為顯著下降-10.4、接者持平沒有顯著變動，而至1997 年後再度呈現顯著下降趨勢，1997-2005 年間平均年死亡率改變百分比為-5.44。結論：本研究認為實施全民健康保險應有改善兒童及青少年的健康照護結果。

Purposes: Before Taiwan established,in 1995, the universal National Health Insurance (NHI) program with comprehensive health benefits for all its citizens, more than 85% of children and adolescents were uninsured. Little is known about the effects of the NHI program on the health outcomesof children and adolescents. Methods: We conducted a nationwide interrupted timeseries (Joinpoint) analysis to examine the effects of the NHIprogram on amenable mortality among children and adolescentsfor the period1981-2005.Age and gender standardized cause-specific mortality rates were calculated from the death and population registry data maintained by the Ministry of Health and Welfare,and the Ministry of the Interior. Results: Our study found the implementation of the NHI program in Taiwan was associated with a significant reduction in deaths from causes amenable to health care, which surpassed the underlying decline in other causes.Two inflection points resulting in three distinct trend periods were identified usingJoinpoint regression between 1981 and 2005. The steady decline in amenable mortality from 1981 (annual percentage change, APC=-10.40) halted in 1987 (APC=-2.85) but then accelerated downwards after 1997 (APC=-5.44). Conclusions: The universal National Health Insurancescheme has improved the health outcomes of children and adolescents in Taiwan.