Transfer of the health care burden of occupational injuries and diseases from labor insurance to national health insurance in Taiwan

Background Occupational injury and diseases result in substantial national health care burden. However, medical costs are often transferred to injured workers or the health insurance system. This study aims to examine the health care service utilization patterns of injured workers under the National Health Insurance (NHI) program in Taiwan and the barriers to medical benefit claims from labor insurance workers' compensation. Methods The total amount spent on medical benefits and national health expenditure from 1980 to 2014 was obtained. Workers who have experienced occupational injuries or diseases were identified in four waves of national surveys, and the types of medical care use were compared. In-depth interviews were conducted with 52 workers who had experienced occupational injuries and diseases. Results Since the implementation of the NHI program in 1995, medical benefits from workers' compensation have dropped substantially. In total, 75% of the workers who experienced occupational injuries or diseases had their medical costs covered through NHI. The time and effort costs caused by barriers against claiming medical benefits from workers' compensation decreased the incentive for workers from certain socioeconomic groups to make workers' compensation claims. Conclusion Medical costs attributable to occupational injuries or diseases were mainly paid through NHI instead of through labor insurance. The economic burden was partially shifted from employers to workers, taxpayers, and the government.