Equity in universal health coverage: do individuals with disabilities benefit equally?

Many countries are moving toward universal health coverage (UHC), but no studies have specifically investigated whether people with disabilities in Taiwan have sufficient financial protection under UHC. This study analyzed the net benefit to people with disabilities under Taiwan's National Health Insurance (NHI) and compared them with those to people without disabilities.

Taiwan's national disability registry and NHI claims data from 2014 to 2021 were used. People with disabilities (n = 933 304) were matched to people without disabilities at a ratio of 1:1. Net benefit was defined as the difference in the total expense (premium plus copayment) to the individual and the total value of medical care received under the NHI. Disability was classified as very severe, severe, moderate, or mild. A two-part model was used to determine factors associated with the net benefit received by people with disabilities.

People with disabilities had significantly higher utilization of outpatient, inpatient, Chinese medicine, and emergency room services, both in terms of the number of visits and expenditure, than did people without disabilities (all P < .001). Among those with mild disabilities, the average net benefit was 62 189 [standard deviation (SD) = 254 684) NTD (new Taiwan dollars)], whereas among those with very severe disabilities, the average net benefit was 461 346 (SD = 557 823) NTD. By comparison, people without disabilities had an average net benefit of 19 969 (SD = 104 351) NTD. However, copayment by people with disabilities was greater than that by nondisabled individuals. Furthermore, regression results showed that income was associated with net benefits under the NHI.

Taiwan's NHI may provide some protection to people with disabilities. However, people with disabilities can be required to pay high copayments, and the redistribution effect of the NHI varies by socioeconomic group.