In 1996, the Taiwan government organized a national-wide and single-payer health insurance program called the “Taiwan National Health Insurance Program” (Taiwan NHIP). Since 1998, the NHIP had covered >99% of the 23 million Taiwanese.[13 ] Consequently, the National Health Research Institutes (NHRI) established the National Health Insurance Research Database (NHIRD) composed of the annual reimbursement claims data from the NHIP.
The present study used the Longitudinal Health Insurance Database (LHID), a subset of NHIRD, to construct the study population. The LHID contained the annual reimbursement claims data from 1 million insured people randomly selected in 1996 to 2000. Based on the NHRI report, the distribution of age and sex ratios between LHID and NHIRD was not different. The NHRI provided a scrambled and anonymous identification number for each insured person to link each claim data, including registry for beneficiaries, out-patient and in-patient visits, and other medical services records. The Institutional Review Board of China Medical University in central Taiwan exempted this study from the informed consent requirement (CMU-REC-101-012).
The disease record in NHIRD was defined by the disease according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Cancer diagnosis database was collected from the catastrophic illness registry and the history of other diseases was gathered from in-patient and out-patient files. The Registry of Catastrophic Illness Database is a subpart of the NHIRD. In Taiwan, insured people with major diseases can apply for a catastrophic illness certificate that grants exemption from copayment. The issuance of catastrophic illness certificates was validated by at least 2 specialists, based on careful evaluation of the medical records, laboratory studies, and imaging studies. Individuals would be issued a catastrophic illness certificate when they meet the diagnostic criteria for major diseases. Cancers, cirrhosis with esophageal varices bleeding, uremia on hemodialysis, and organ failure are statutorily included in the catastrophic illness category.
The present study used the Longitudinal Health Insurance Database (LHID), a subset of NHIRD, to construct the study population. The LHID contained the annual reimbursement claims data from 1 million insured people randomly selected in 1996 to 2000. Based on the NHRI report, the distribution of age and sex ratios between LHID and NHIRD was not different. The NHRI provided a scrambled and anonymous identification number for each insured person to link each claim data, including registry for beneficiaries, out-patient and in-patient visits, and other medical services records. The Institutional Review Board of China Medical University in central Taiwan exempted this study from the informed consent requirement (CMU-REC-101-012).
The disease record in NHIRD was defined by the disease according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Cancer diagnosis database was collected from the catastrophic illness registry and the history of other diseases was gathered from in-patient and out-patient files. The Registry of Catastrophic Illness Database is a subpart of the NHIRD. In Taiwan, insured people with major diseases can apply for a catastrophic illness certificate that grants exemption from copayment. The issuance of catastrophic illness certificates was validated by at least 2 specialists, based on careful evaluation of the medical records, laboratory studies, and imaging studies. Individuals would be issued a catastrophic illness certificate when they meet the diagnostic criteria for major diseases. Cancers, cirrhosis with esophageal varices bleeding, uremia on hemodialysis, and organ failure are statutorily included in the catastrophic illness category.
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