全民健保子宮頸抹片檢查受檢率影響因子分析-個體時間序列資料之實證研究，1997~2000

Objective: The National Health Insurance (NHI) program in Taiwan has provided free annual Pap smear screening for women aged over 30 since July, 1995. However, the rate of Pap smear screening is still low. In this study, we studied how demand and supply side factors such as SES and medical resource availability influenced Pap smear screening patterns under the NHI in Taiwan between 1997 and 2000. Method: Instead of using cross-sectional survey data, we adopted a fixed cohort sample (N=20608) through employing the NHI claim and administration files. The method of Generalized Estimating Equations was conducted to estimate the screening pattern over time. Factors associated with receiving no Pap smear screening during the 4-year study period were also examined. Results: Women whose income was below the tax return filing requirement were 1.22 times and 1.28 times more likely to have no routine screening and be unscreened for the entire study period than those at upper income levels. It seems that the availability of medical resource had a weaker influence on screening behavior. However, women living in rural towns were less likely to conduct routine screening and more likely to be unscreened for 4 years than those living in urban towns. Conclusions: Our results indicate that 52% of women were not screened over the 4-year period. Attention should be focused on these high- risk women and lower social economic status groups.