Abstract
Shortages and maldistribution of dermatology services have negative impacts on the quality of care for patients with skin problems. Only a limited amount of literature is available regarding the current state of dermatologic services in Taiwan. The aim of this study was to examine the urban-rural distribution of dermatologists and office-based dermatology services in Taiwan. Data regarding dermatology workforce and their geographic distribution were collected from the Taiwan Medical Association, Taiwan Dermatological Association, and Department of Household Registration, Ministry of the Interior, while data on the locations and opening hours of dermatologic clinics were sourced from the National Health Insurance Administration. The locations and opening times of dermatologic clinics were stratified by urbanisation levels. There were 4.27 dermatologists per 100 000 persons in Taiwan. Taipei City was the most dermatologist-dense area (9.61 dermatologists per 100 000 people), while Lienchiang County had no dermatologists at all. Among the 444 office-based dermatologic clinics in Taiwan, the overwhelming majority were located in urban (77.5%) and suburban (20.9%) areas, with two-thirds of towns in Taiwan (67.1%, n=247) having no dermatologic clinics at all. On average, the clinics provided 14.9 service sessions per week (standard deviation 3.04). Altogether, only 57.1% of the rural clinics were open during any of Saturday evening, Sunday daytime and Sunday evening, while the corresponding percentage was 75.9% for urban areas. Statistical analysis shows that the open ratios in suburban areas were significantly lower than those in urban areas on Saturday evening, Sunday daytime and Sunday evening (p<0.001), while urban and rural areas had no significant difference in open ratios on these three sections. In Taiwan, dermatologists are unevenly geographically distributed, with most practising in urban areas. Also, there are remarkable urban-rural disparities in the availability of services on Saturday evening, Sunday daytime and Sunday evening.
Highlights
Shortages and maldistribution of dermatology services have negative impacts on the quality of care for patients with skin problems
According to one 2001 study in the USA, 36.5% of patients presenting to primary care physicians had at least one skin problem, with that problem being the chief complaint for 58.7% of those patients[20]
A 2006 study in Taiwan found that 26.0% of outpatients had at least one skin condition, and that patients with skin diseases accounted for 5.4% of total ambulatory care visits[22]
Summary
Shortages and maldistribution of dermatology services have negative impacts on the quality of care for patients with skin problems. The aim of this study was to examine the urban–rural distribution of dermatologists and office-based dermatology services in Taiwan. Only 57.1% of the rural clinics were open during any of Saturday evening, Sunday daytime and Sunday evening, while the corresponding percentage was 75.9% for urban areas. 99.9% of Taiwan’s population is covered by the NHI program It is a government-administered insurance-based national healthcare system. In Taiwan in 2013, most of the dermatologic services were provided in physician clinics (86.4%), followed by metropolitan hospitals (5.9%), academic medical centres (4.7%) and local community hospitals (3.0%)[9]. As for the workforce distribution according to facility levels, most dermatologists practised in physician clinics (69.5%, n=818), followed by academic medical centres (18.7%, n=220), metropolitan hospitals (9.8%, n=115) and local community hospitals (2.0%, n=23)[10]. In Taiwan in 2013, 52.6% of the patients with skin diseases visited dermatologists for help, compared with 32.6% who visited non-dermatologists and 14.8% who visited both[12]
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