Utilization factors and effects of national health insurance on cervical Pap smear tests in Taiwan

Objectives: In Taiwan, although cervical cancer is one of the most common cancerous conditions in females, it is the easiest to detect early by the cervical Papnicolaou (Pap) smear test and therefore treat effectively. The purpose of this study is to evaluate the utilization factors and effects of universal health insurance on cervical Pap smear tests in Taiwan. Method: This study invited 10,780 married women aged 30-64 years old living in seven communities of Taiwan since 1991. Database sources were from the cervical cancer research project and linked to the national files of the cervical neoplasia screening registry, cancer registry, and death certification from the department of health. Multinomial Logistic Regression and Cox's Proportional Hazard Model analysis were performed. Result: The low utilization factors of regular Pap smear tests were a low education level, and irregular Pap smear tests prior to the beginning of national health insurance. On the other hand, high utilization factors included women who had ever had the cervical Pap smear test or gynecological diseases prior to study entry, no insurance, Pap smear test/cervicgraphy positive finding or regular Pap smear tests prior to July 1995. The results of regular Pap smear tests were better than irregular ones. Conclusion: Although we thoroughly analyzed the results of regular one-year, two-year, and three-year Pap smear test outcomes, it is unclear as to which time period was better. However the women at a high risk of developing cervical cancer are encouraged to have regular Pap smear tests for the early detection and treatment of cervical neoplasia, therefore effecively saving medical costs.