International Journal of
Medicine and Medical Sciences

  • Abbreviation: Int. J. Med. Med. Sci.
  • Language: English
  • ISSN: 2006-9723
  • DOI: 10.5897/IJMMS
  • Start Year: 2009
  • Published Articles: 531

Full Length Research Paper

Enhancing quality of healthcare under the national health insurance system: Identification of factors reducing quality of care in Taiwan

Li Chang
  • Li Chang
  • Department of Business Administration, Shih Hsin University, No. 111, Mu-cha Rd., Sec. 1, Taipei 116, Taiwan
  • Google Scholar

  •  Accepted: 28 July 2011
  •  Published: 30 August 2011



This study examines whether the quality of community health in Taiwan has improved after the establishment of the National Health Insurance (NHI); to identify what the related factors are that affect the quality, and to find the possible ways to improve key drivers of healthcare quality. Data were collected from the National Health Insurance Annual Statistics Information Database and the Taipei Health Information Indices Database in the form of unbalanced panel of 153 hospital-years from 1989 to 2002 in 13 Taipei public hospitals within different districts. In addition, panel data analysis with fixed effects model was conducted to identify what factors affected the quality of healthcare before and after the advent of the NHI. After the NHI, quality of care improved insignificantly. The elderly, market competition, new technology, average length of stay (LOS), scale, physician density and nurse to patient ratio were all major factors affecting quality. Moreover, lower doctor density, longer LOS and increased in the number of elderly led to deterioration in the quality of care. The government could improve quality of elder-care by encouraging the re-building of three-generation family values. Policymakers should also permit public hospitals to institute the incentive programs for their professional staffs. In addition, quality could be improved by having hospital managers who enhance efficiency by decreasing the LOS.


Key words: Quality, drivers of quality, national health insurance.