Trends in rural and urban differentials in incidence rates for ruptured appendicitis under the National Health Insurance in Taiwan

Huang, Nicole; Yip, W. C. L.; Chang, Hong; Chou, Yiing Jenq

doi:10.1016/j.puhe.2006.06.011

Cited by 54 publications

(45 citation statements)

References 35 publications

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“…While previous studies have found that the utilization rates for medical services in urban areas are higher than those in remote areas [1][2][3][4][5][6][7][8][9][10][11][12], these studies have demonstrated limitations. Firstly, such studies in the past have tended to only explore the urban-rural regional variations, but have not focused on the level of urbanization of the community in which the individuals are located.…”

Section: Introductionmentioning

confidence: 92%

“…A large number of studies have shown that individuals utilize medical services differently depending on whether they reside in rural or urban areas [1][2][3][4][5][6][7][8][9][10][11][12]. Compared to those that form part of urban populations, individuals living in rural areas are generally less likely to obtain timely medical care services [1][2][3]10,[12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Compared to those that form part of urban populations, individuals living in rural areas are generally less likely to obtain timely medical care services [1][2][3]10,[12][13][14][15][16]. Studies have pointed out that the lower utilization of physician services in these rural areas could be due to either the inferior socioeconomic status of the residents (e.g., lower education or income) [5,[9][10][11]17], or alternatively critical per capita shortages of hospital beds, physicians, nurses, and specialists [3,5,10,12,13]. In addition, geographical factors such as the distances or time taken to travel between a patient's residence and the closest service provider, as well as the lack of insurance coverage [1][2][3][4]8,[10][11][12][18][19][20][21][22][23] are other significant reasons that affect the utilization to medical care services.…”

Section: Introductionmentioning

confidence: 99%

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Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan

2011

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Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan

2011

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“…Studies revealed the causes that patients did not seek or use health services in the case of emergency for reasons including lack of financial support, knowledge, resources or technology [17][18][19], and that patients' use of services tended to decline with distance or transport costs [20][21][22]. The emergency utilisation and resources allocation are even more serious in poor regions, and there is significant difference between urban and rural areas in Chongqing.…”

Section: Introductionmentioning

confidence: 99%

Analysis of the equity of emergency medical services: a cross-sectional survey in Chongqing city

et al. 2015

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Background: Due to reform of the economic system and the even distribution of available wealth, emergency medical services (EMS) experienced greater risks in equity. This study aimed to assess the equity of EMS needs, utilisation, and distribution of related resources, and to provide evidence for policy-makers to improve such services in Chongqing city, China. Methods: Five emergency needs variables (mortality rate of maternal, neonatal, cerebrovascular, cardiovascular, injury and poisoning) from the death surveillance, and two utilisation variables (emergency room visits and rate of utilisation) were collected from Chongqing Health Statistical Year Book 2008 to 2012. We used a concentration index (CI) to assess equality in the distribution of needs and utilisation among three areas with different per-head gross domestic product (GDP). In each area, we randomly chose two districts as sample areas and selected all the medical institutions with emergency services as subjects. We used the Gini coefficient (G) to measure equity in population and geographic distribution of facilities and human resources related EMS. Results: Maternal-caused (CI: range −0.213 to −0.096) and neonatal-caused (CI: range −0.161 to −0.046)deaths declined in 2008-12, which focusing mainly on the less developed area. The maternal deaths were less equitably distributed than neonatal, and the gaps between areas gradually become more noticeable. For cerebrovascular (CI: range 0.106 to 0.455), cardiovascular (CI: range 0.101 to 0.329), injury and poisoning (CI: range 0.001 to 0.301) deaths, we documented a steady improvement of mortality; the overall equity of these mortalities was lower than those of maternal and neonatal mortalities, but distinct decreases were seen over time. The patients in developed area were more likely to use EMS (CI: range 0.296 to 0.423) than those in less developed area, and the CI increased over the 5-year period, suggesting that gaps in equity were increasing. The population distribution of facilities, physicians and nurses (G: range 0.2 to 0.3) was relatively equitable; the geographic distribution (G: range 0.4 to 0.5) showed a big gap between areas. Conclusions: In Chongqing city, equity of needs, utilization, and resources allocation of EMS is low, and the provision of such services has not met the needs of patients. To narrow the gap of equity, improvement in the capability of EMS to decrease cerebrovascular, cardiovascular, injury and poisoning cases, should be regarded as a top priority. In poor areas, allocation of facilities and human resources needs to be improved, and the economy should also be enhanced.

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Investigating unmet health care needs under the National Health Insurance program in Taiwan: A latent class analysis

Tian

2018

Health Planning & Management

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Summary Objectives In Taiwan, although the implementation of the National Health Insurance (NHI) program reduced financial barriers and enhanced accessibility for individuals to utilize health care services, an unequal distribution of medical care resources still exists. This paper is focusing on analyzing factors that are associated with unmet health care needs among the middle‐aged and elderly under the NHI in Taiwan. Methods Statistical analysis from the 2007 Survey of Health and Living Status of the Elderly in Taiwan. We firstly adopted latent class analysis to classify individuals' observable reasons for feeling unwell but not seeing a doctor within the last 3 months into three latent perceived barriers classes. We further used a multinomial probit regression model to analyze factors that are associated with each perceived barrier class to the access of health care service. Results Results indicate relative to the “relatively no barriers” class, individuals with a high level of educational attainment tend to more likely to be in the “accommodation barriers” class, and individuals live in the most developed areas with the densest medical facilities tend to less likely to be in the “accessibility barriers” class. Conclusions We identified possible risk factors for each perceived barrier, which could provide important insights for health authorities and medical providers when targeting policies and interventions to efficiently assist people in need.

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Trends in rural and urban differentials in incidence rates for ruptured appendicitis under the National Health Insurance in Taiwan

Cited by 54 publications

References 35 publications

Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan

Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan

Analysis of the equity of emergency medical services: a cross-sectional survey in Chongqing city

Investigating unmet health care needs under the National Health Insurance program in Taiwan: A latent class analysis

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