The Impacts of the Hierarchical Medical System on National Health Insurance on the Resident’s Health Seeking Behavior in Taiwan: A Case Study on the Policy to Reduce Hospital Visits
Abstract
:1. Introduction
2. Materials and Methods
2.1. Research Sample and Source of Data
2.2. Questionnaire Framework and Design
2.3. Data Processing and Analysis Method
3. Results
3.1. Analyses of the Basic Information of the Research Subjects
3.2. Analyses of the Impact of the Hierarchical Medical System and the Policy to Reduce Outpatient Visits to Large Hospitals on Residents’ Healthcare-Seeking Behavior
4. Discussion
5. Suggestions
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A. Questionnaires
Questionnaires of hierarchical medical system and reduce outpatient visits (7 questions) |
1. Are you aware that the National Health Insurance Administration is implementing “hierarchical medical system”? |
2. Are you aware that the Health Insurance Department will increase the co-payment without introducing a referral system? |
3. Are you aware that you can reduce your waiting time by referral system? |
4. Are you aware that the National Health Insurance Administration has implemented a “hierarchical medical system” to seek medical advice when there is a disease? |
5. Are you aware that the National Health Insurance Administration outpatient clinics in major hospitals will reduce the number of visits year after year? |
6. Are you aware that the National Health Insurance Administration has implemented a large number of outpatient clinics and hopes to change the people’s medical habits? |
7. Are you aware about the freedom of choice? |
Questionnaires of healthcare-seeking behavior (14 questions) |
1. Waiting time in the clinic will affect my choice of medical care. |
2. The attitude of medical staff will affect my choice of medical care. |
3. The reputation of the physician will affect my choice of medical care. |
4. The quality of doctors and medical skills will affect my choice of medical care. |
5. The medical institution is very close to where I live, which will affect my choice of medical care. |
6. The reputation of a medical institution will affect my choice of medical care. |
7. Medical equipment in medical institutions will affect my choice of medical care. |
8. The medical quality of medical institutions will affect my choice of medical care. |
9. The new medical technology of the medical institution will affect my choice of medical care. |
10. The social responsibility of medical institutions will affect my choice of medical care. |
11. The crisis management ability of medical institutions will affect my choice of medical care. |
12. Health insurance policy will affect my choice of medical care. |
13. Health care hierarchical medical system will affect my choice of medical care. |
14. Large hospital outpatients will reduce the choice of medical care. |
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Measure | Not Aware | % | Partially Aware | % | Completely Aware | % | χ2 |
---|---|---|---|---|---|---|---|
Gender | 0.486 | ||||||
Women | 205 | 15.3 | 353 | 26.3 | 221 | 16.5 | |
Men | 150 | 11.2 | 268 | 20.0 | 143 | 10.7 | |
Age (years) | <0.001 | ||||||
≤29 | 18 | 1.3 | 95 | 7.1 | 112 | 8.4 | |
30–39 | 57 | 4.3 | 131 | 9.8 | 109 | 8.1 | |
40–49 | 76 | 5.7 | 150 | 11.2 | 50 | 3.7 | |
50–59 | 98 | 7.3 | 107 | 8.0 | 51 | 3.8 | |
≥60 | 106 | 7.9 | 138 | 10.3 | 42 | 3.1 | |
Marital status | <0.001 | ||||||
Single | 121 | 9.0 | 221 | 16.5 | 176 | 13.1 | |
Married | 213 | 15.9 | 368 | 27.5 | 174 | 13.0 | |
Divorced | 21 | 1.6 | 32 | 2.4 | 14 | 1.0 | |
Annual income | <0.001 | ||||||
No income | 80 | 6.0 | 142 | 10.6 | 71 | 5.3 | |
≤NTD 200,000 | 24 | 1.8 | 87 | 6.5 | 69 | 5.1 | |
NTD 200,001–400,000 | 98 | 7.3 | 164 | 12.2 | 93 | 6.9 | |
NTD 400,001–600,000 | 73 | 5.4 | 130 | 9.7 | 73 | 5.4 | |
≥NTD 600,000 | 80 | 6.0 | 98 | 7.3 | 58 | 4.3 | |
Educational level | <0.001 | ||||||
Junior high school | 18 | 1.3 | 14 | 1.0 | 21 | 1.6 | |
Senior high school | 99 | 7.4 | 210 | 15.7 | 77 | 5.7 | |
University | 205 | 15.3 | 361 | 26.9 | 225 | 16.8 | |
Graduate School | 33 | 2.5 | 36 | 2.7 | 41 | 3.1 | |
Occupation | <0.001 | ||||||
Students | 50 | 3.7 | 113 | 8.4 | 89 | 6.6 | |
Military and public servants | 59 | 4.4 | 57 | 4.3 | 33 | 2.5 | |
Private organizations | 171 | 12.8 | 276 | 20.6 | 183 | 13.7 | |
Worked | 44 | 3.3 | 83 | 6.2 | 27 | 2.0 | |
Others | 31 | 2.3 | 92 | 6.9 | 32 | 2.4 |
Measure | Healthcare-Seeking Behavior | |
---|---|---|
Beta | t | |
Gender (RG: Women) | ||
Men | 0.001 | 0.043 |
Age (RG: ≥60) | ||
≤29 | −0.035 | −0.744 |
30–39 | −0.001 | −0.038 |
40–49 | −0.060 | −1.832 * |
50–59 | 0.005 | 0.161 |
Marital status (RG: Single) | ||
Married | 0.015 | 0.418 |
Divorced | 0.008 | 0.269 |
Annual income (RG: No income) | ||
≤NTD 200,000 | −0.041 | −1.303 |
NTD 200,001–400,000 | 0.020 | 0.397 |
NTD 400,001–600,000 | −0.026 | −0.534 |
≥NTD 600,000 | −0.017 | −0.345 |
Educational level (RG: University) | ||
Junior high school | −0.082 | −3.001 ** |
Senior high school | −0.014 | −0.456 |
Graduate School | 0.042 | 1.543 |
Occupation (RG: Private organizations) | ||
Students | −0.064 | −1.289 |
Military and public servants | −0.022 | −0.798 |
Worked | 0.050 | 1.322 |
Others | −0.019 | −0.685 |
Policy understanding (RG: Partially aware) | ||
Completely aware | −0.032 | −1.166 |
Not aware | 0.119 | 4.243 *** |
Independent variable | ||
Knowledge of the hierarchical medical system and the policy to reduce outpatient visits to large hospitals | 0.405 | 15.894 *** |
R2 | 0.188 | |
Adj. R2 | 0.176 | |
F-value | 15.317 | |
p-value | <0.001 |
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Yan, Y.-H.; Kung, C.-M.; Yeh, H.-M. The Impacts of the Hierarchical Medical System on National Health Insurance on the Resident’s Health Seeking Behavior in Taiwan: A Case Study on the Policy to Reduce Hospital Visits. Int. J. Environ. Res. Public Health 2019, 16, 3167. https://doi.org/10.3390/ijerph16173167
Yan Y-H, Kung C-M, Yeh H-M. The Impacts of the Hierarchical Medical System on National Health Insurance on the Resident’s Health Seeking Behavior in Taiwan: A Case Study on the Policy to Reduce Hospital Visits. International Journal of Environmental Research and Public Health. 2019; 16(17):3167. https://doi.org/10.3390/ijerph16173167
Chicago/Turabian StyleYan, Yu-Hua, Chih-Ming Kung, and Horng-Ming Yeh. 2019. "The Impacts of the Hierarchical Medical System on National Health Insurance on the Resident’s Health Seeking Behavior in Taiwan: A Case Study on the Policy to Reduce Hospital Visits" International Journal of Environmental Research and Public Health 16, no. 17: 3167. https://doi.org/10.3390/ijerph16173167