title: No gynecologist in town: the gynecological care of women in rural Taiwan.
abstract: BACKGROUND
  A shortage of gynecologists exists in many countries. Even within an affluent country, gynecological clinics might not be evenly distributed. The purpose of the study was to investigate the disparity in gynecological care between adult women living in towns with and without gynecologists in Taiwan.
  
  
  METHODS
  Data sources were the cohort datasets of the National Health Insurance Research Database, with claims data of 1 million beneficiaries in 2010. A woman's residency was operationally inferred from the locations where she had most frequently visited physicians' clinics or local community hospitals within the year.
  
  
  RESULTS
  In Taiwan, 145 (39.4%) of 368 towns had no practicing gynecologist. Of 382,167 women with health care use in the datasets, 21,794 (5.7%) lived in towns without a gynecologist. The overwhelming majority of these towns lay in sparsely populated, rural areas. During the year, 132,702 women (34.7%) had sought medical help for gynecological diseases and 113,698 (29.8%) had visited gynecologists for gynecological diseases. Women in towns without a gynecologist were less likely to consult for gynecological diseases (23.8% versus 35.4%; P<0.001) and visit gynecologists (18.7% versus 30.4%; P<0.001) than women in towns with a gynecologist. The disparity existed in each age group. Among 5,189 adult women living in towns without a gynecologist and having gynecological diseases, 78.5% (number [n]=4,074) visited gynecologists out of town, especially for infertility, benign disorders of the uterus and ovaries, gynecological examinations, and contraceptive problems, and by contrast 23.3% (n=1,209) visited nongynecologists in town, most commonly for menopausal disorders, endometriosis and pelvic pain, menstrual disorders and hormonal dysfunction, and genital dysplasia.
  
  
  CONCLUSIONS
  Gynecological care of rural women was adversely affected by the shortage of gynecologists. The consequences of accessibility in underserved areas deserve further investigation.
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Li-Jung
authors.initials: LJ
authors.lastname: Lai
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Chou
authors.affiliation: Department of Reproductive Medicine, University of California, San Diego, CA, USA.
authors.forename: H Irene
authors.initials: HI
authors.lastname: Su
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: Department of Public Finance, National Chengchi University, Taipei, Taiwan.
authors.forename: Li-Fang
authors.initials: LF
authors.lastname: Chou
authors.affiliation: Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan ; Department and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan ; College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yueh-Ching
authors.initials: YC
authors.lastname: Chou
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan ; Department of Family Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shinn-Jang
authors.initials: SJ
authors.lastname: Hwang
authors.affiliation: Taipei Veterans General Hospital Hsinchu Branch, Hsinchu County, Taiwan ; Department of Healthcare Management, Yuanpei University, Hsinchu, Taiwan.
authors.forename: Hann-Chin
authors.initials: HC
authors.lastname: Yu
keywords: gynecological care; urban–rural health service; women’s health