Objectives: To investigate the nationwide epidemiology of acute pancreatitis (AP) in a developing country, with emphasis on the contribution of intensive care patients. Methods: We analyzed hospital patients with first-episode AP between 2005 and 2007, based on the claims data of a nationally representative sample of 1,000,000 people enrolled in the Taiwan National Health Insurance program. Severe AP was defined according to a modified Atlanta classification. Results: A total of 1693 patients with AP were identified. Crude and adjusted incidence rates of AP in 2005 were 56.9 and 42.8 per 100,000 persons, respectively. The age-specific incidence rates increased continuously with age in women, but showed a bimodal distribution in men. Severe AP was present in 20.4% of the patients; 47.4% of them received intensive care. The hospital days and charges of those receiving intensive care accounted for 22.1% of the total hospital days and for 40.8% of the total hospital charges of all patients with AP, respectively. Hospital mortality was 2.7%, ranging from 0.3% in nonsevere cases to 18.9% in those requiring intensive care. Conclusions: In Taiwan, 20% of patients with AP were severe; although only half of them received intensive care, they used significant resources and accounted for most deaths.