• Sessions
• Presentations
• Posters
• Rooms

Presentation

Session: Experience with Primary Care
Room: Meeting Rooms 22+23
Time: Thu 16:00-17:15

Presenter: Mei-ling Sheu (Taipei Medical University. School of Health Care Administration)

Abstract

In contrast to many countries when long waiting time is an issue, easy access is one of the key features of Taiwan’s health care system in which patients have the freedom to choose providers. However, because of the lack of a gate keeping mechanism, virtually physicians in all types of health care institutions, hospitals or clinics, can be primary care providers. Similar to the ‘retail clinics’ in the US or the ‘walk-in centers’ in the UK, many clinics in Taiwan mainly provide treatment for minor illnesses and injuries and have long opening hours. However, it is the physician, many of them a trained specialist, who provides these services. Over the past two decades, due to policy encouragement, more and more physicians got specialty and subspecialty licenses in addition to their MD license. Besides, their career choices and practice patterns are also deeply influenced by the policies of National Health Insurance (NHI). Among them is the global budgeting system, where the clinic and the hospital sectors have separate budgets (starting from 2001 and 2002, respectively). To discourage hospitals from providing too many primary care services, an index of primary care rate has been used to monitor hospitals’ performance. Consequently, hospitals have been decreasing their primary care rates. The purpose of this study is to examine the extent to which the distributions of physician specialties in these two sectors have changed, and to try to identify how the changes might have influenced the provision of primary care under the global budgeting system. The main data source is the monthly outpatient claim data of NHI from 2000 to 2005. The key variable is primary care rate per month for different types of providers, with the number of primary cases as the numerator and the total number of outpatient cases as the denominator. The definition of primary care was established by the Bureau of NHI with ICD9-CM codes based on empirical findings and professional opinions. Preliminary findings by comparing the data in Decembers of 2000 and 2005 (23,523 and 27,614 physicians) suggested that more physicians got specialty and subspecialty licenses. Moreover, physicians of different specialties had different growth rates. The average primary care rates also varied among different specialties, between different sectors, and over time. While the decreasing trend in primary care rates in hospitals were already known, the clinic sector also exhibited lower average primary care rates. It could be a signal which showed that more clinicians were providing more specialized and/or wider scope of care. We will further try to analyze the variations in health expenditure among different types of primary care physicians controlling for other available variables such as sex, age and area, using the same data set with the GEE models. Finally, we will discuss policy implications for Taiwan including the concept of primary care, primary care organization and resource allocations in the health care system.

Key Terms

primary care, national health insurance, physician workforce, global budgeting

Authors:

Mei-ling Sheu (Taipei Medical University. School of Health Care Administration) , Yue-chune Lee (National Yang-Ming University. Institute of Health and Welfare) and Shin-chung Huang (Bureau of National Health Insurance. Medical Affairs Division)

Search with Google