OBJECTIVES: The health care delivery system and personal income are two factors that affect equity in medical care. How deep is the impact of these two factors? We examine the impact of two related factors 1) the implementation of a compulsory National Health Insurance (NHI) program in 1995 and(2) the recession in 2001 on equity in health care finance and utilization in Taiwan. METHODS: We assumed that Burden of Health Payment (BHP) and Health Care Expenditure (HCE) were more precise measurements of equity in health care finance and utilization, respectively. The BHP was defined as the ratio of the sum of the premium and out-of-pocket spending to disposable income. We used the 1992- 2002 data to examine the following hypotheses at the individual level, categorized into five income quintiles: Hypothesis 1: Equity in BHP and HCE improves after having the NHI program. Hypothesis 2: Equity in BHP and HCE deteriorates with recession. We categorized the data into five income quintiles. RESULTS: This study confirms the two hypotheses. NHI can narrow the disparity in medical care equity, but recession can widen it. We found that the BHP was regressive, while the HCE for the poorest is significantly higher than that for the others. We also found that the recession of 2001 had a significantly greater impact on the poor versus the rich quintile. In conclusion, NHI reform is still an unfinished job. CONCLUSIONS: The resource allocations need to be rearranged whenever a recession occurs.