An Investigation into Rural Access to Medical Care in the US and Taiwan
DOI:
https://doi.org/10.58445/rars.4231Keywords:
rural healthcare, health disparities, Taiwan healthcare system, US healthcare system, comparative healthcare, medical accessAbstract
Taiwan and the United States both struggle to provide equitable, accessible care for citizens living within rural communities. This disparity creates unequal access to care in rural regions and contributes to varying health outcomes between urban and rural populations. This paper compares the strengths and weaknesses of each nation's healthcare system with an emphasis on healthcare in rural regions. Through a literature review analyzing the organization, delivery, funding, resource shortages, and key rural healthcare programs of the two healthcare systems, this paper examines how the two nations address rural healthcare inequalities and proposes an improved model that combines their most effective approaches. Sources were primarily drawn from online databases and government healthcare agencies, with most published from 2015 to the present. However, older sources were also included when relevant. In particular, both countries face significant challenges in healthcare access, physician shortages, and limited access to specialists. However, Taiwan excels in coordinated rural outreach programs and healthcare coverage, while the US benefits from advanced medical innovation in providing quality healthcare. Ultimately, although no system is perfect, improving rural healthcare requires balancing accessibility, quality, and long-term financial sustainability.
References
Arredondo, K., Touchett, H. N., Khan, S., Vincenti, M., & Watts, B. V. (2023). Current programs and incentives to overcome rural physician shortages in the United States: A narrative review. Journal of General Internal Medicine, 38(3), 916–922. https://doi.org/10.1007/s11606-023-08122-6
Bahirwani, J., Changela, M., Bharadwaj, H. R., & Dahiya, D. S. (2025). When geography dictates care: The rural gastroenterology challenge. ACG Case Reports Journal, 12(12), e01944. PubMed Central. https://doi.org/10.14309/crj.0000000000001944
Balakrishnan, K., Li, Z., Hinkle, H. E., Weidenbacher-Hoper, V. L., Reynolds, C., & Keesee, A. O. (2025). Predictors of rural hospital closures in the United States: A systematic review and call for AI-driven early warning systems. BMC Health Services Research, 26, 86. https://doi.org/10.1186/s12913-025-13847-7
Bureau of National Health Insurance, Department of Health. (2009). National health insurance in Taiwan (pp. 1–70). Bureau of National Health Insurance. https://media.nhi.gov.tw/md/dl-51789-4706dfa8e4a84565a445e7f35afda974-3.pdf
Centers for Disease Control and Prevention. (2024, May 14). About rural health. Rural Health. https://www.cdc.gov/rural-health/php/about/index.html
Commonwealth Fund. (2026, May 1). International health care system profiles: Taiwan. https://doi.org/10.26099/R631-C728
Cyr, M. E., Etchin, A. G., Guthrie, B. J., & Benneyan, J. C. (2019). Access to specialty healthcare in urban versus rural US populations: A systematic literature review. BMC Health Services Research, 19, Article 974. https://doi.org/10.1186/s12913-019-4815-5
Flex Monitoring Team. (2004). Historical CAH Data. Flexmonitoring.Org. https://www.flexmonitoring.org/historical-cah-data-0
Gunja, M. Z., Gumas, E. D., & Williams II, R. D. (2026). U.S. health care from a global perspective, 2026. Commonwealth Fund. https://doi.org/10.26099/2egm-8b76
Ho Chan, W. S. (2010). Taiwan’s healthcare report 2010. EPMA Journal, 1(4), 563–585. https://doi.org/10.1007/s13167-010-0056-8
Horstman, C., & Shah, A. (2025). The state of rural primary care in the United States. The Commonwealth Fund Website. https://doi.org/10.26099/03v3-h645
Hsieh, C.-L., Chung, C.-Y., Chen, H.-Y., Shieh, S.-H., Hsieh, M.-S., & Hsieh, V. C.-R. (2023). Bridging geographical disparities across 368 townships with healthcare system and socioeconomic factors in Taiwan. Scientific Reports, 13(1), 15007. https://doi.org/10.1038/s41598-023-42124-y
Jia, Y., Li, Y., Cai, X., & Enumah, S. J. (2026). Payer mix shifts and profitability at critical access hospitals, 2011 to 2023. Health Affairs Scholar, 4(4), qxag083. https://doi.org/10.1093/haschl/qxag083
Kapp, J. M., Underwood, B., Ressel, K., & Quinn, K. (2023). Practice perspectives on care coordination in rural settings. Professional Case Management, 29(1), 4–12. https://doi.org/10.1097/NCM.0000000000000679
Kirby, J. B., & Yabroff, K. R. (2020). Rural–urban differences in access to primary care: Beyond the usual source of care provider. American Journal of Preventive Medicine, 58(1), 89–96. https://doi.org/10.1016/j.amepre.2019.08.026
Lin, Y.-H., Tseng, Y.-H., Chen, Y.-C., Lin, M.-H., Chou, L.-F., Chen, T.-J., & Hwang, S.-J. (2013). The rural - urban divide in ambulatory care of gastrointestinal diseases in Taiwan. BMC International Health and Human Rights, 13, 15. https://doi.org/10.1186/1472-698x-13-15
National Association of Community Health Centers. (n.d.). What is a Community Health Center? Retrieved August 30, 2026, from https://www.nachc.org/community-health-centers/what-is-a-health-center/
National Health Insurance Administration, Ministry of Health and Welfare. (2022a, June 8). Referral services. https://www.nhi.gov.tw/en/cp-31-68c21-17-2.html
National Health Insurance Administration, Ministry of Health and Welfare. (2022b, June 9). How premiums are calculated. https://www.nhi.gov.tw/en/cp-1112-0dec1-201-2.html
National Health Insurance Administration, Ministry of Health and Welfare. (2022c, August 15). The NHI payment system. https://www.nhi.gov.tw/en/cp-1057-890fd-123-2.html
National Health Insurance Administration, Ministry of Health and Welfare. (2022d, August 19). NHI for rural health care- IDS 20th anniversary conference in Taoyuan Fuxing District. https://www.nhi.gov.tw/en/cp-1019-ad966-8-2.html
NIHCM Foundation. (2023, October 25). Rural health: Addressing barriers to care. Nihcm. https://nihcm.org/publications/rural-health-addressing-barriers-to-care
Rural Health Information Hub. (2021, April 22). Rural health clinics (RHCs) introduction - rural health information hub. Rural Health Information Hub. https://www.ruralhealthinfo.org/topics/rural-health-clinics
Scott, D. (2016). United States health care system: A pharmacy perspective. The Canadian Journal of Hospital Pharmacy, 69(4), 306–315. https://www.cjhp-online.ca/index.php/cjhp/article/view/1585/2393
Taipei Times. (2025, September 28). Notes from Central Taiwan: The urban-rural divide in Taiwan’s medical coverage. https://www.taipeitimes.com/News/feat/archives/2025/09/29/2003844590
Tsuei, Sian Hsiang-Te. (2024). Reflection on 30 years of Taiwanese national health insurance: Analysis of Taiwanese health system progress, challenges, and opportunities. Journal of the Formosan Medical Association, 123(Suppl 3), S180–S187. https://doi.org/10.1016/j.jfma.2024.07.030
US Census Bureau. (2024, December 16). Urban and Rural. The United States Census Bureau. https://www.census.gov/programs-surveys/geography/guidance/geo-areas/urban-rural.html
U.S. Centers for Medicare & Medicaid Services. (n.d.). Health insurance plan & network types: HMOs, PPOs, and more. HealthCare.Gov. Retrieved September 13, 2026, from https://www.healthcare.gov/choose-a-plan/plan-types/
Wang, S.-I., & Yaung, C.-L. (2013). Vertical equity of healthcare in Taiwan: Health services were distributed according to need. International Journal for Equity in Health, 12, 12. https://doi.org/10.1186/1475-9276-12-12
Worldometer. (n.d.). Taiwan demographics (population, age, sex, trends). Www.Worldometers.Info. Retrieved September 1, 2026, from https://www.worldometers.info/demographics/taiwan-demographics/
Wu, T.-Y., Majeed, A., & Kuo, K. N. (2010). An overview of the healthcare system in Taiwan. London Journal of Primary Care, 3(2), 115–119. https://doi.org/10.1080/17571472.2010.11493315
Xirasagar, S., & Lin, H. C. (2004). Cost convergence between public and for-profit hospitals under prospective payment and high competition in Taiwan. Health Services Research, 39(6 Pt 2), 2101–2116. https://doi.org/10.1111/j.1475-6773.2004.00334.x
Yang, C.-H., Huang, Y.-T. A., & Hsueh, Y.-S. A. (2013). Redistributive effects of the National Health Insurance on physicians in Taiwan: A natural experiment time series study. International Journal for Equity in Health, 12, 13. https://doi.org/10.1186/1475-9276-12-13
Yu, T.-H., Chung, K.-P., Wei, C.-J., Chien, K.-L., & Hou, Y.-C. (2016). Do the preferences of healthcare provider selection vary among rural and urban patients with different income and cause different outcome? PLOS ONE, 11(4), e0152776. https://doi.org/10.1371/journal.pone.0152776
Downloads
Posted
Categories
License
Copyright (c) 2026 Research Archive of Rising Scholars

This work is licensed under a Creative Commons Attribution 4.0 International License.