Evaluation of Taiwan's National Health Insurance policy: an importance-satisfaction analysis

The hypothesis that policy performance affects citizens' satisfaction with public policies could be considered a well-worn topic. However, this paper shows that the extant literature has not adequately conceptualized nor addressed the relationship, which could exist between citizens' satisfaction and importance of the evaluation's indicators. The findings of most previous studies reflect elite perspectives on Taiwan's National Health Insurance (NHI) policy evaluation, and the importance of the evaluation's indicators may not be recognized by the public. In addition, previous satisfaction studies have not provided information on the level of evaluative indicator importance. This study utilized importance-satisfaction analysis to examine public preferences of the NHI policy and assigned weights for NHI policy evaluation indicators by administering a national phone survey in October 2009. A total of 1103 telephone interviews were conducted with people aged 20 years and older, comprising a sample that was representative of the Taiwanese population according to age, gender, and area of residence. Furthermore, to explore the difference between expected importance and perceived satisfaction, this study calculated a reconceptualized performance gap. To obtain the gap value for an indicator, the mean value for importance was subtracted from the mean value for satisfaction. The findings imply that public recognition and support constitute the premise for the successful operation and reform of the NHI policy. The study concludes that policy adjustment is needed in several areas where importance outweighed satisfaction, including access to medical care services and NHI efficiency. The results suggest public recognition of and satisfaction with the evaluation indicators in use and the need for policy adjustment in areas where importance outweighs satisfaction.