Health in Whose Hands? Impacts of National Health Insurance on Social Solidarity and Individual Responsibility: Evidence from the World Values Survey of Taiwan

Purpose: The impact of state-organized welfare systems on solidarity attitudes remains uncertain due to the limited availability of longitudinal data. This study aimed to examine changes in collective solidarity and individual responsibility attitudes in Taiwan following the implementation of the National Health Insurance (NHI) scheme, using data from the World Values Survey (WVS). Methods: We conducted a repeated cross-sectional analysis using WVS data from 1995 (pre-NHI implementation) and 2005 (post-NHI implementation). Participants were Taiwanese adults aged 18 and older. Generalized Linear Mixed Models (GLMMs) were used to evaluate factors influencing solidarity attitudes. Age- and Sex-Matched 1:1 Matching was applied to balance covariates, and the Likelihood Ratio Test (LRT) was used to assess the significance of the effect of the NHI policy. Results: Our findings demonstrated stronger collective solidarity among female participants, greater perceptions of unfairness among respondents, and lower quality of life among those reporting unfairness. GLMM analysis revealed a significant reduction of 0.70 units in government responsibility scores a decade after the NHI implementation (β = -0.70, p < 0.0001), indicating increased perceptions of government responsibility. The Likelihood Ratio Test confirmed improved model fit when incorporating NHI policy effects (likelihood ratio = 4.2, p = 0.0404). Conclusion: Taiwan’s NHI system reinforces collective solidarity and concurrently promotes perceptions of individual responsibility. Notably, females, perceived fairness, and lower quality of life are significant factors associated with greater reliance on government healthcare provision.