Taiwan’s Hospital Distribution and the Access to Emergency Care: A Longitudinal Analysis
Date Issued
2010
Date
2010
Author(s)
Liu, Shin-Ting
Abstract
Background and Objectives:
Previous studies on emergency medical services were about the influcing factors of emergency medicare utilization,few were foucing on the access to emergency care.Partly,the extrapolativeness of past researches has been limited while lacking longitudinal analysis about the changes in Taiwan’s hospital distribution and the access to emergency care at the same time.The purposes of this study were:
(1) To Understand the changes in Taiwan’s hospital and emergency department(ED)
distribution in 63 sub-region in past decade.
(2) To Examine the effect of number of provider toward ED visits and cross-region ED
visits,by cross-sectional and longitudinal analysis.
Materials and Methods:
Subjects between 50 and 70 years-old ,with more than one physicianisit or ED visit in Taiwan were included by using the NHI claim data.We investigate the 63 sub-region area to describe the distribution of emergency hospitals from 1997 to 2007.Data for the analysis came from twenty-five sets of the cohort database from the National Health Insurance research database. Each set included 40,000 persons randomly sampled from the NHI enrollees who were insured during 1997 to 2007.
A cross-sectional analysis was conducted to describe the impact of the number of emergency hospital in Taiwan on accessibility of emergency care in 1997,2002 and 2007 by multiple linear regression.Generalized estimating equation model was used to investigate the longitudinal analysis between number of emergency hospital and and ED visit,cross-region ED visit during 1997 to 2007.
Results and Conclusions:
During 1997-2007，the number of emergency hospitals remain stable in Taiwan.We find there are more sub-area proving emergency care and the ED visits has been increasing,yet the cross-region ED visits has been decreasing in past decade.In 1997,2002,2007,after controlling the other factors,the number of emergency hospitals has strongly positive effect on emergency utilization(β = 4.237,p<.0001),and strongly negative effect on the proportion of cross-region ED visit (β=-2.366,p=0.0001).The’’time’’variable has a strong, positive effect on emergency utilization(β = 2.866,p<.0001) and strong,negative effect on cross-region ED visit( β = -1.946,p=0.001).However,there is no interaction effect between emergency hospital number and year.According to the study result,the health authority should strengthen the fountion of existing emergency hospitals,especially in remote districts ,to make sure the equability in emergency medicare resource.
Subjects
Emergency Medical Services
Utilization
Cross-region
Longitudinal Analysis
Type
thesis
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