title: Trends in rural and urban differentials in incidence rates for ruptured appendicitis under the National Health Insurance in Taiwan.
abstract: OBJECTIVE
  Rural-urban disparities in health remain a major focus of concern. This population-based study examined the performance of Taiwan's universal healthcare system in reducing rural-urban disparities in health, through better accessibility. Changes in the rates of ruptured appendicitis were compared between residents of remote and non-remote areas in Taiwan, under the National Health Insurance (NHI) programme.
  
  
  METHODS
  We identified all 128,930 patients undergoing appendectomy in Taiwan between 1996 and 2001. The NHI inpatient files, enrolment files, major disease files, hospital registry and the household registry were linked to provide comprehensive individual and hospital information. Probit regression analyses were used to obtain adjusted estimates.
  
  
  RESULTS
  During the first 3 years, although the differences between the remote and non-remote areas were apparent, they were seen to be narrowing. This downward trend continued, and, since 1999, few discernible differences have been observed. After adjusting for individual and hospital characteristics, over time, the ruptured appendix rate among remote area residents was seen to be decreasing significantly faster (1.1%) than among non-remote area residents. More specifically, the children showed a substantially steeper narrowing trend (3.3%) in rural-urban disparities, than did adults.
  
  
  CONCLUSIONS
  Our findings have shown a significant narrowing of health disparities between remote and non-remote populations, resulting from free access to care and more healthcare provision in remote areas under the NHI programme; particular success has been observed in rural children. Although certain disparities still exist, Taiwan's universal healthcare system has effectively reduced rural-urban disparities in access to care and in ultimate health outcomes.
authors.affiliation: Institute of Public Health, National Yang Ming University, 155 Ni-Long Street, Taipei 112, Taiwan, ROC.
authors.forename: N
authors.initials: N
authors.lastname: Huang
authors.forename: W
authors.initials: W
authors.lastname: Yip
authors.forename: H-J
authors.initials: HJ
authors.lastname: Chang
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Chou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000706:statistics & numerical data; D001064:Appendicitis / Q000453:epidemiology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008507:Medically Underserved Area; D008875:Middle Aged; D009313:National Health Programs / Q000592:standards*; D012422:Rupture, Spontaneous / Q000453:epidemiology* / Q000209:etiology; D012423:Rural Health / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000191:economics / Q000600:supply & distribution*; D013624:Taiwan / Q000453:epidemiology; D014504:Urban Health / Q000706:statistics & numerical data*