De-Jhen Kuo
Department of Health Administration, Tzu-Chi College of Technology

Abstract
Women's Pap smear screening in Taiwan was 42-55% and lower than most other
countries. But contacted rate for medical services was higher than ninety percent. In 2009, per
capita visits to out-patient departments measured 15.0.
Objectives: This study examined the correlation between several aspects related to
medical utilization and the receipt of a Pap smear exam among middle-aged and elderly
women in a national representative dynamic cohort in Taiwan over an eight year period.
Subject age and annual odds ratios were also considered.
Methods: The study population consists of women aged 40 years and over in Taiwan.
Our data, provided by National Health Research Institutes, are the sampled registry
information of 44,222 beneficiaries of National Health Insurance from 1997 to 2004. The
dependent variable was receipt of a Pap smear exam. The independent variables were specific
year, subject age, occurrence of outpatient visits, Chinese medicine practitioner visits,
emergency room visits, dental treatment visits, with/without chronic disease, undergoing
dialysis treatments, receiving home care services, receiving preventive care, classification as
an inpatient, undergoing HRT treatment, receipt of bone density exam, and receipt of
mammography exam. We used the generalized estimating equation （GEE） model for
repeated measurement analysis.
Results: Although the annual contact rate of outpatient visits was more than 85%, a
continuously declining trend was indicated. The annual contact rate of emergency department
visits was between 12 ~ 14%, with a slight increase over time. The annual contact rate of
Chinese medicine visits remained generally stable and between 31 ~ 33%. The annual contact
rate of dental treatment visits was between 29 ~ 34%, with an increasing trend. A steadily
rising trend was noted in the annual contact rates of chronic diseases out-patient, with rates
increasing from 46% to 53% over the period of this study. Although the visiting numbers for
dialysis treatments increased two-fold, the annual contact rates remained less than 1%. The
visiting numbers of home care services increased more than five-fold, but the rates remained
less than 1%. A notable increase was seen in the visiting numbers for preventive care as it
increased from 7,811 people to 15,246 people, showing a similar increase in annual rate from
24% to 34.5%. The screening rate of bone density was lowest in 2003 and highest in 1999,
this may be attributable to the Taiwan Bureau of Health, Promotion of Health Department
implementation of subsides for bone density examination. The number of mammography use
nearly tripled, and the annual contact rate more than doubled, yet the rate remained below 1%.
Conclusions: The overall number of screenings by Pap smear more than doubled during
the study period, and the annual contact rate for Pap smears （PSAR） increased from 13% to
a peak of nearly 26% in 2001, followed by a modest decline. The odds ratio for Pap smear
（ORPS） for age 40 to 49 year old women was the highest at 2.67. With the notable
exceptions of “dialysis treatment” and “home care services” all other aspects of medical
utilization in this study presented ORPS greater than 1.0, indicating a positive correlation.
Base on the results, we offer two recommendations. Firstly, the government should encourage
hospitals to promote Pap smear screening programs, especially among dialysis patients.
Secondly, medical professionals in contact with home care patients should encourage them to
undergo cancer screenings.