Accessibility assessment of the Health Care Improvement Program in rural Taiwan.
BACKGROUND
An experimental Health Care Improvement Program (HCIP) was initiated by the Bureau of National Health Insurance in 1997 to improve the accessibility of health care in several rural, mountainous districts.


OBJECTIVE
This longitudinal study evaluated service availability, utilization patterns, and effectiveness of services under the HCIP in the A-Li Mountain District.


METHODS
Outpatient claims made by residents in the A-Li Mountain District were extracted from the database of the National Health Insurance program. Changes in utilization pattern and volume were analyzed. Satisfaction levels were assessed by 2-stage face-to-face interviews with local residents.


RESULTS
After the HCIP, the average population served by each doctor decreased 75%, and total outpatient visits increased 15.4%. The total number of in-district outpatient visits increased 83.6%. The proportion of in-district outpatient visits to all visits increased from 22.1% to 35.1%. The total in-district outpatient visit fee claimed increased 100.2%, and the total out-of-district outpatient visit fee claimed increased only 7.2%. About 60.4% of the residents were not satisfied with overall health care services before the HCIP. The proportion decreased to 32.4% after the HCIP.


CONCLUSIONS
The HCIP improved accessibility, enriched local medical care resources, changed the utilization pattern of some residents, and increased residents' satisfaction level. A well-managed program with stabilized financial resources is more likely to succeed if it also respects cultural differences and responds to community needs.
Tan
Hsiu-Fen
HF
Department of Health Care Administration, Chung Jung Christian University, Taiwan, Republic of China. ttan@mail.cju.edu.tw
Tseng
Hung-Fu
HF
Chang
Chen-Kang
CK
Lin
Wender
W
Hsiao
Shih-Huai
SH
D000328:Adult; D000368:Aged; D005260:Female; D006284:Health Plan Implementation / Q000592:standards / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D015397:Program Evaluation; D019035:Rural Health Services / Q000592:standards / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors