Can Health Insurance Boost Fertility? The Fertility Effect of National Health Insurance in Taiwan

健康保險能促進生育率嗎？臺灣全民健保對生育率的影響

麥麗施(Elyse Mark) ； 蘇昱璇(Yu-hsuan Su)

《第十屆發展研究年會　台灣經驗2.0：在地與全球的發展研究與實踐》 2018 (2018/10) Pp. 641-685

https://doi.org/10.6392/ACDS.201810.0026

摘要

The implementation of Taiwanese National Health Insurance (NHI) in 1995 affected almost every Taiwanese citizen's healthcare options and coverage. Inclusion of low-cost prenatal and postnatal care, delivery services, and child healthcare coverage indicates the implicit pronatalism of NHI policy. Given the endogeneity of healthcare availability to childbearing decisions, this study uses the 1995 implementation of NHI to estimate the impact of national healthcare on Taiwanese fertility. NHI may influence the fertility decision in the two opposite directions: increasing fertility through lowered cost of childbearing, or decreasing fertility through less motivation for raising children to provide for family members in old age. Using the 1979-2016 waves of the Women's Marriage, Fertility, and Employment Survey, we first approach this question using OLS regressions to test for correlation between completed childbearing and NHI, among other demographic factors. In the second approach, difference-in-differences methodologies estimate the effect of 1995 NHI implementation on the treatment group of Taiwanese women and state-insured control group. Our results from both approaches reject the hypothesis that lowered cost of childbearing through NHI stimulated Taiwanese fertility.

關鍵字

Taiwan ； National Health Insurance ； fertility ； difference in differences

並列摘要

自1995年臺灣實施全民健康保險起，健保幾乎影響了所有臺灣居民的醫療選擇。臺灣的健保包括產前和產後檢查、分娩服務、兒童保健的費用補助，表明健保政策潛在的鼓勵生育性。本研究利用1995年全民健保的實施估計國家醫療保健對臺灣生育率的影響，首先用普通最小平方法估計完成生育子女數與健保以及其他的人口因素之間的相關性，並使用差異中之差異方法來估計健保實施對實驗組和對照組的影響。我們的數據來源是内政部1979年至2016年的婦女婚育與就業調查。我們假設1995年的健保政策減緩了臺灣婦女自1980年代開始的生育率下降趨勢。然而，普通最小平分析未能顯示健保與臺灣婦女生育率的正相關。此外，使用母親年齡和受孕時間作為截止點的差異中之差異估計也拒絕了通過健保降低生育成本會刺激臺灣生育的假設。

並列關鍵字

臺灣 ； 全民健康保險 ； 生育率 ； 差異中之差異