The Impacts of National Health Insurance on the Private Health Insurance Market and Medical Care Utilization: Evidence from Taiwan

In this doctoral dissertation, I focus on the long-term effect of national health insurance (NHI) on the private health insurance market and analyze the effects of NHI on the utilization of medical care in Taiwan. In the private health insurance market, my results based on a 12-year unique data set and Difference-in-Difference (DID) models with Propensity Score Matching methods (PSM) reveal that public health insurance does not crowd out private health insurance. The evidence supports the significant increases in the private health insurance coverage ratio in the long run as insurers simultaneously adjusted their product strategies. We also find that the implementation of NHI has a crowding-in effect on households for different income levels. In the utilization of medical care in Taiwan, I adopt a two-part model that combines PSM with the DID method to estimate the causal effect of Taiwan’s NHI on outpatient and inpatient care in terms of both probability and frequency. The main finding is that the impacts on outpatients are considerably larger than on inpatients following the implementation of NHI. In addition, the results also suggest that young females increase the frequency of their hospital stays more than those of males. For different age groups, I find that the elders increase the utilization of medical services significantly after the implementation of NHI. I also find that the degree of the increase in the Incidence of cancers has been smaller following the implementation of NHI, especially for Cervical Carcinoma. The mortality rate cause by the cancers has also stopped increasing