| Summary: | 碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 103 === Abstract
Background: There are many reports concerning the urban-rural differences in health care. The indicators used include life expectancy, infant mortality rate, and mortality rate of specific disease. However, life expectancy is not sensitive enough to reveal the urban-rural gap in health care. Besides, there are limitations in using mortality rates for specific diseases to explain the differences. In 1993, Institute of Medicine in the United States reported that “Hospitalization for Ambulatory Care Sensitivity Conditions” is a good indicator to monitor access to health care services. The key concept of ambulatory care sensitive conditions (ACSCs) is ‘‘for which good outpatient care can potentially prevent the need for hospitalization or for which early intervention can prevent complications or more severe disease‘‘. This study aims to analyze the health care differences between urban and rural areas using hospitalization for ACSCs as a measure for health outcome in Taiwan.
Purpose: To examine the association between the urbanization and hospitalization for ACSCs, and further investigate whether the access to health care services is the mediator between ACSC hospitalizations and urbanization.
Materials and methods: This is a cross-sectional study. All data is from the academic database of National Health Insurance (NHI) in National Health Research Institute. We analyzed the one million ebrollees data on the year of 2010, who has been enrolleed in 2005.The study included those were 18 years and older in 2010. Using methods suggested by previous researchers, we tried to identify the residantal area for each of the NHI enrollees in our study by using insurance classification, location of clinic/hospital visit, and insurance registration information, and we excluded those enrollees whose residence could not be identified. A total of 568,641 persons were included in the analysis. We divided the sample into three groups by the level of urbanization, and adjusting for sex, age, comorbidity, the number of physician visits and socioeconomic status variables in the models. Besides, we use the Statistical Mediation Analysis (Baron& Kenny) to examine whether access to health care is a mediator between the urban-rural gap and hospitalization for ACSCs.
Results: Among the 586,641 subjects, there were 9230 persons admitted with ACSCs.The rates of ACSC hospitalization were 14.62%, 16.19%, and 17.36% by the level of urbanization from high to low level. According to the multiple logistic regression modles, the higher the level of urbanization the lower the rates of ACSC hospitalization (P<0.0001). Besides, we found that access to health care was a partial mediator between the urbanization and hospitalization for ACSCs.
Conclusion : Our study found that the rates of hospitalization for ACSCs differs between the urban and rural areas, and the accessibility to primary care is a partial mediator of this association.
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