TY - JOUR
T1 - Universal health insurance, health inequality and oral cancer in Taiwan
AU - Wang, Fuhmei
AU - Wang, Jung Der
AU - Hung, Yu Wen
N1 - Funding Information:
This work was supported by grants from the National Science Council of Taiwan (Grant no. NSC 102-2314-B-006-029-MY2, NSC 102-2811-B-006-018 and NSC101-314-Y-006-001), Ministry of Health and Welfare of Taiwan (DOH102-TD-C-111-003), and the Ministry of Science and Technology of Taiwan (Grant no. MOST 105-2410-H006-091). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript with the registered number of 201006061R.
Publisher Copyright:
© 2018 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Introduction The introduction of universal health insurance coverage aims to provide equal accessibility and affordability of health care, but whether such a policy eliminates health inequalities has not been conclusively determined. This research aims to examine the healthcare outcomes of oral cancer and determine whether the universal coverage system in Taiwan has reduced health inequality. Methods Linking the databases of the National Cancer Registry with the National Mortality Registry in Taiwan, we stratified patients with oral squamous cell carcinoma by gender and income to estimate the incidence rate, cumulative incidence rate aged from 20 to 79 (CIR20-79), life expectancy, and expected years of life lost (EYLL). The difficulties with asymmetries and short follow-up periods were resolved through applying survival analysis extrapolation methods. Results While all people showed a general improvement in life expectancy after the introduction of the NHI, the estimated change in EYLL’s of the high-, middle-, and low-income female patients were found to have +0.3, -0.5 and -7 years of EYLL, respectively, indicating a reduction in health inequality. Improvements for the male patients were unremarkable. There was no drop in the CIR20-79 of oral cancer in disadvantaged groups as in those with higher incomes. Conclusions Universal coverage alone may not reduce health inequality across different income groups for oral cancer unless effective preventive measures are implemented for economically disadvantaged regions.
AB - Introduction The introduction of universal health insurance coverage aims to provide equal accessibility and affordability of health care, but whether such a policy eliminates health inequalities has not been conclusively determined. This research aims to examine the healthcare outcomes of oral cancer and determine whether the universal coverage system in Taiwan has reduced health inequality. Methods Linking the databases of the National Cancer Registry with the National Mortality Registry in Taiwan, we stratified patients with oral squamous cell carcinoma by gender and income to estimate the incidence rate, cumulative incidence rate aged from 20 to 79 (CIR20-79), life expectancy, and expected years of life lost (EYLL). The difficulties with asymmetries and short follow-up periods were resolved through applying survival analysis extrapolation methods. Results While all people showed a general improvement in life expectancy after the introduction of the NHI, the estimated change in EYLL’s of the high-, middle-, and low-income female patients were found to have +0.3, -0.5 and -7 years of EYLL, respectively, indicating a reduction in health inequality. Improvements for the male patients were unremarkable. There was no drop in the CIR20-79 of oral cancer in disadvantaged groups as in those with higher incomes. Conclusions Universal coverage alone may not reduce health inequality across different income groups for oral cancer unless effective preventive measures are implemented for economically disadvantaged regions.
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U2 - 10.1371/journal.pone.0205731
DO - 10.1371/journal.pone.0205731
M3 - Article
C2 - 30335806
AN - SCOPUS:85055076042
SN - 1932-6203
VL - 13
JO - PloS one
JF - PloS one
IS - 10
M1 - e0205731
ER -