Social Determinants of Health in Taiwan

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Social Determinants of Health in Taiwan

• The 12th World Congress on Public Health in
  Istanbul
• The Hilton Hotel Istanbul Convention Center
• April 27 - May 1, 2009
• T.L. Chiang
• College of Public Health, National Taiwan
  University
• E-mail tlchiang_at_ntu.edu.tw

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T.L. ChiangE-mail tlchiang_at_ntu.edu.tw

• Professor and Dean, College of Public Health,
  National Taiwan University
• Sc.D. Department of Health Policy and Management,
  School of Hygiene and Public Health, Johns
  Hopkins University, 1984
• One of three full-time academic members of
  Taiwans National Health Insurance Planning
  Taskforce, 1988-1990

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TAIWAN - 2007

• Socioeconomic background
• population 23 million
• density 635 persons per square km
• GNP US17,252 per capita
• education 34 received higher education
• aging 10.2 population
• Population health
• life expectancy M/F 75/81 yrs
• major killers cancer, stroke, accident
• heart disease, diabetes

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HEALTH TRANSITION Taiwan, 1920-2020
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Taiwans NHI THE BIRTH OF TAIWANs NHI
Full Congress Election
Democratic Progressive Party
US De-Recognition
NHI Law
Withdraw from UN
President Election
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MAJOR FEATURES OF NHI

• Universal coverage
• Comprehensive benefits
• Western medicine, Chinese medicine
• ambulatory care, EMS, inpatient care, home care
• coinsurance rate of 10-20 plus
• Public single-payer
• National global budget
• Health spending as of GDP - 6.2 in 2007

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ANY USE of PHYSICIAN SERVICES Before and After
the NHI
Source Cheng HS, Chiang TL. The effect of
universal health insurance on health care
utilization in Taiwan results from a natural
experiment. JAMA 1997 27889-93.
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ANY USE of HOSPITAL SERVICESBefore and After the
NHI
Source Cheng HS, Chiang TL. The effect of
universal health insurance on health care
utilization in Taiwan results from a natural
experiment. JAMA 1997 27889-93.
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CATASTROPHIC HEALTH SPENDINGW/out and With NHI,
2004
Out-of-pocket health spending exceeds 40 of
household non-food consumption
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TREND IN AGE-ADJUSTED MORTALITYTaiwan, 1987-2002
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ALL CAUSES MORTALITYBefore and After NHI
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UNDER FIVE CHILD MORTALITY1990 vs 2000 Birth
Cohorts
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DETERMINANTS OF HEALTHGo Upstream
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DETERMINANTS OF HEALTH Healthy Taiwan 2020
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• Healthy Taiwan
• ????
• ????????
• To increase healthy life expectancy
• ???????
• To promote health equity

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Thank You !!