The impact of National Health Insurance on neonatal care use and childhood vaccination in Taiwan

The objective of this study was to assess the impact of National Health Insurance (NHI) on the utilization of neonatal care and childhood vaccination in Taiwan. Data are selected from two nationwide maternal and infant surveys undertaken in 1989 and 1996, which were funded by the Department of Health. The questionnaire was administered in all 23 administrative districts, including two metropolitan areas - the cities of Taipei and Kaohsiung. The first and second cohort consisted of 1641 and 3499 infants, respectively. This study used a bivariate probit estimation procedure to examine the factors that determine the probability of neonatal care use and vaccination by pooling the 2 years. Generally, the mothers who are older, more educated and more satisfied with birth delivery services were found to be more likely to use neonatal preventive care. The likelihood of receiving such care also tends to rise with advancing gestational age and higher probability of neonatal complication (icterus neonatorum) and being born in a hospital. The likelihood of care was also found to vary regionally with northern neonates having higher odds of receiving preventive care than non-northern neonates. In spite of having an insignificant impact on the use of care, NHI does lessen the inequality in use of these two services in various regions. However, regional variations in neonatal care use still exist. Residents of the southern area remain less likely to receive neonatal care than those of the northern area after NHI. This finding deserves serious consideration when attempting to design effective policies, such as expanding medical institutions in the aboriginal southern areas so as to increase the accessibility of such health care.