Huang N, Yip W, Chang H-J, Chou Y-J
Institute of Public Health, National Yang Ming University, 155 Ni-Long Street, Taipei 112, Taiwan, ROC.
Public Health. 2006 Nov;120(11):1055-63. doi: 10.1016/j.puhe.2006.06.011. Epub 2006 Oct 2.
Rural-urban disparities in health remain a major focus of concern. This population-based study examined the performance of Taiwan's universal healthcare system in reducing rural-urban disparities in health, through better accessibility. Changes in the rates of ruptured appendicitis were compared between residents of remote and non-remote areas in Taiwan, under the National Health Insurance (NHI) programme.
We identified all 128,930 patients undergoing appendectomy in Taiwan between 1996 and 2001. The NHI inpatient files, enrolment files, major disease files, hospital registry and the household registry were linked to provide comprehensive individual and hospital information. Probit regression analyses were used to obtain adjusted estimates.
During the first 3 years, although the differences between the remote and non-remote areas were apparent, they were seen to be narrowing. This downward trend continued, and, since 1999, few discernible differences have been observed. After adjusting for individual and hospital characteristics, over time, the ruptured appendix rate among remote area residents was seen to be decreasing significantly faster (1.1%) than among non-remote area residents. More specifically, the children showed a substantially steeper narrowing trend (3.3%) in rural-urban disparities, than did adults.
Our findings have shown a significant narrowing of health disparities between remote and non-remote populations, resulting from free access to care and more healthcare provision in remote areas under the NHI programme; particular success has been observed in rural children. Although certain disparities still exist, Taiwan's universal healthcare system has effectively reduced rural-urban disparities in access to care and in ultimate health outcomes.
城乡健康差距仍是主要关注焦点。这项基于人群的研究通过改善可及性，考察了台湾全民健康保险制度在缩小城乡健康差距方面的成效。在全民健康保险计划下，比较了台湾偏远地区和非偏远地区居民阑尾炎穿孔发生率的变化。
我们确定了1996年至2001年间在台湾接受阑尾切除术的所有128,930名患者。将全民健康保险住院档案、参保档案、重大疾病档案、医院登记册和户籍登记册相链接，以提供全面的个人和医院信息。使用概率单位回归分析来获得调整后的估计值。
在最初3年里，尽管偏远地区和非偏远地区之间的差异很明显，但这些差异在缩小。这种下降趋势持续存在，自1999年以来，几乎没有明显差异。在调整了个人和医院特征后，随着时间推移，偏远地区居民的阑尾炎穿孔发生率下降速度明显快于非偏远地区居民（1.1%）。更具体地说，城乡差距在儿童中缩小的趋势（3.3%）比成年人中更显著。
我们的研究结果表明，全民健康保险计划下偏远地区可免费获得医疗服务且医疗供给增加，使得偏远和非偏远人群之间的健康差距显著缩小；在农村儿童中成效尤为显著。尽管仍存在某些差距，但台湾的全民健康保险制度有效缩小了城乡在获得医疗服务及最终健康结果方面的差距。
