Taiwan's hospital distribution and access to emergency care: A longitudinal analysis

Background&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)Display the changes in Taiwan's hospital and emergency department(ED)distribution in 63 sub-region in past decade.(2)Analyze the effect of number of provider toward ED visits and cross-region ED visits,by cross-sectional and longitudinal analysis.Materials&Methods:Subjects between 50-70 years-old,with more than one physicianisit or ED visit in Taiwan were included by using the NHI claim data.Data for the analysis came from twenty-five sets of the cohort database from 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 1997,2002and2007 by multiple linear regression.Generalized estimating equation model was used to investigate the longitudinal analysis between number of emergency hospital and ED visit,cross-region ED visit during 1997to2007.Results&Conclusions:During 1997-2007,there are more sub-area provding emergency care and the ED visits has been increasing,yet the cross-region ED visits has been decreasing in past decade.In1997,2002,2007,after controlling the other factors,the number of emergency hospitals has positive effect on emergency utilization(ß=4.237,p<.0001),and negative effect on the proportion of cross-region ED visit(ß=-2.366,p=.0001).The”time”variable has a positive effect on emergency utilization(ß=2.866,p<.0001)and negative effect on cross-region ED visit(ß=-1.946,p=.001)