I think this framework could also be used to do a similar study in a country like the United States where healthcare is expensive. It might be instructive to test to see if subjects who lived in countries where healthcare is much cheaper had different
perceptions of the system in the United States from the point of view of US residents. The method suggests that these peoples’ direct experience abroad with a cheaper system would alter their expectations, ideals, and perceptions to make them see the US system as more expensive.
Another further study that this research invites is a wider one based on the Scaled Data Method and whether that method of questioning can produce useful results. I am very interested at what could be learned by asking the Direct Experience questions to a much larger sample. It could go far beyond healthcare related study. I am very curious to
82
see if this would be a good way to link subjective views with objective situations.
8.6 Policy Implications
This research also suggests several important policy initiatives. One of them, which was not the point of the study, but was revealed by accident, was how laypeople are largely unaware of the premium and how it is calculated. This sample was very educated compared to the regular population yet very few knew that most of the burden of funding the NHI fell on employers and very few were aware of what the actual premium rate was. The NHI needs to do a better job of raising the consciousness of laypeople on how their own system works.
Laypeople who had experience abroad had views closer to that of Policy Experts on the questions of the biggest problems and how to fix them. The different departments of the government responsible for policy marketing the NHI should try to replicate that effect. They could do something that is the reverse of the American example in the literature review. In that example, the private insurers used misleading statistics and endeavored to keep laypeople from making international comparisons as a way to prevent policy reform. This study suggests that the NHI might get results from doing the reverse, by using true statistics to get laypeople to make international comparisons and therefore bring their perceptions more in line with policy experts. The study showed that those who had experience abroad were likely to be conscious how inexpensive the Taiwan system is.
That could be an important consideration when trying to break legislative gridlock with regards to new reforms.
If such education works in Taiwan, then it could be generalizable to the rest of the world and help governments and citizenry everywhere make more informed decisions about how healthcare in their countries is structured. With world population aging and healthcare becoming more expensive worldwide, a way to give people a better
perspective on their own system’s strengths and limitations will be increasingly important.
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Appendix 1 - Questionnaire
Subject designation:
Background
1. Gender/性別 Male/男 □ Female/女 □
2. Age/年齡 □ 18-24 □25-34□ □35-44 □45-54 □55-64 □ 65以上 3. Education/教育程度
□middle school/國中 □highschool/高中 □Associate's/vocational degree/專科
□bachelor's degree/大學 □ Graduate degree/研究所以上 4. Profession/employer 職業是什麼？ If self employed, please mark which
industry【回答「自由業」者，請追問是從事哪種性質的工作】If retired, unemployed, or not working please mark your most recent job.
【回答「失業、無業、退休」者，請追問失業、無業、退休前的工作】
□Government scientist/researcher/政府部門研究人員／科學家
□ Private sector scientist/researcher/私人部門研究人員／科學家
□ Public healthcare公立醫療單位技術人員（醫師、藥師、護士、醫療人員）
□ Private healthcare 非公立醫療單位技術人員（醫師、藥師、護士、醫療人員）
□ Artist (actors, performers worker, photographer) or Literary ( writer , reporter , playwright ) /藝術工作者（演員、表演工作者、攝影師）或 文字工作者（作家、記者、劇作家）
□ Government Administration/政府主管 □ Government staff/職員
□ Private Enterprise/民營事業 □ Public Enterprise /公營事業
□NGO/非政府组織 □Education/教育
□ Legal / 律師，法官、書記官、檢察官 □ student/學生
□ Religious or spiritual organization/宗教工作者 □ emergency services/軍警調人員
□ Unemployed, retired/待業失業退休者 □ Homemaker/家管
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□ Other (please record_________)/其他_______請記錄
□ Decline to answer拒答
5. What is your usual monthly income? /請問您每個月的收入大概是多少錢？
□ none/沒有收入 □ <19,999 NTD/一萬九千元以下
□ 20,000-39,999 NTD/二萬元至三萬九千元 □ 40,000-59,999 NTD/四萬元至五萬九千元
□ 60,000-79,999 NTD/六萬元至七萬九千元 □ 80,000-99,999 NTD/八萬元至九萬九千元
□ >100,000 NTD/十萬元以上 □ I don't know/I choose not to answer 不知道／拒答
6. Have you been covered under Taiwan's NHI? 你是否有臺灣的健康保險？
□ Yes/是 □ No/不是
7. Have you ever lived abroad? 你是否曾經住過國外？
□ Yes/是 □ No/不是
If yes, where and for how long? 若有，那裏？住多久？
Where?/哪裏？_____________ How long? 住多久?_____________
8. Have you ever been covered by the health system of another nation (besides the US or Taiwan)? 你曾經有否別的國家的建保福利嗎？
□ Yes/是 □ No/不是
9. Have you ever been responsible for the health care of another person i.e. spouses or children? 你是否曾經須負擔自己以外的健保費用？
□ Yes/是 □ No/不是
10. How would you describe your health? 你覺得自己的健康狀況程度好壞？
Poor /不健康 □1 □2 □3 □ 4 □ 5 healthy/身體健康
USA Section
What kind of healthcare coverage do you have in the United States?
在美國，你是否有建保，若有，是何種健保呢？
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If you broke a bone and had to go to the hospital, describe what you think would happen？ 如果你不小心折斷了骨頭,而需要去醫院,那你認爲會發生什麽事呢?請描述。
What kind of treatment would you receive? 你覺得自己會受到何樣的治療？
怎麽樣？
A) Would it be expensive to treat? (1-5 scale) 你覺得這樣的治療貴不貴呢
？用一到五回答。
Cheap/便宜 □1 □2 □3 □ 4 □ 5 Expensive/貴 B) How much is that in monetary terms? 那你覺得大概會是多少錢呢？
A) How long would it take to get treatment? 您認爲等候治療的時間很久嗎？
(1-5 scale very quick – very long time) 用一到五回答
fast/快 □1 □2 □3 □ 4 □ 5 long time/很久 B) How much time would you estimate that to be? 您預估多久等候治療的時間？
2. Have you ever used the health system in the United States? 在美國，你曾經有 看過醫生嗎？
Yes/去過□ No/沒去過□
Did you use it for urgent or routine care? 那麽是因爲平常的保健患有疾病，或 是緊急事故呢？
Urgent/緊急事故□ Routine/平常的□ Both/都有 □ How did you choose your doctor? 你怎麽選擇你的醫生？
3. Where do you go when you see the doctor in the US? (private clinics, hospitals
etc.) 看醫生的時候，你會選擇去診所或醫院？
4. A) How often do (did) you go to the doctor while in the US? (1-5 almost never -
very often ) 在美國，你多常看醫生？ 用一到五回答（1 指徒未有，5 指經
常）包括健康檢查。
almost never/徒未有 □1 □2 □3 □ 4 □ 5 very often/經常 B) What does that mean in times per year? 答案是指一年多少次？
5. If you're comfortable, describe your most recent experience going to the doctor in
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the U.S. 如果你方便的話，可否請你描述最近一次在美國使用健保的經驗？
6. A) How would you describe the cost of your care? 你覺得個人負擔的費用貴不 貴？ 用一到五。1 cheap -5 expensive)
Cheap/便宜 □1 □2 □3 □ 4 □ 5 Expensive/貴 B) How much was that roughly? 健保負擔的治療費用是多少錢？
7. A) Did it take a long time to to get treatment?你等候治療的時間很久嗎？ (1-5 scale)
fast/快 □1 □2 □3 □ 4 □ 5 long time/很久
B) How much time would you estimate that to be? 您預估要等候治療的時間多久？
8. A) Do you feel like your care took a reasonable amount of time? 你覺得候診時 間合理的快慢程度？一到五同意不同意 (1-5 agree disagree)
Strongly agree/極同意 □1 □2 □3 □ 4 □ 5 Strongly disagree/極不同意 B) What would be a reasonable amount of time?那麽候診時間大概是多久？
9. How do you feel about the quality of care in the American healthcare system?
(1-5 scale)你覺得美國健保制度的品質好壞？ 1-5 點
Excellent quality/那麽好 □1 □2 □3 □ 4 □ 5 Terrible quality/很壞
10. How convenient is it to go the doctor in the US? (1-5 most to least convenient) 在美國你覺得看醫生的方便的程度？一到五標好到壞
Very convenient/很方便 □1 □2 □3 □ 4 □ 5 Very inconvenient/很麻煩 11. Describe the most important problem with the American healthcare system? 請
描述美國的健保制度中最嚴重的問題是什麽？
How do you think it could be fixed? 那麽你覺得應如何改進呢？
12. What is the best aspect of the American healthcare system? 請描述美國的健保
12. What is the best aspect of the American healthcare system? 請描述美國的健保