| Summary: | 碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 104 === Background: Along with the development of medical technology, the world population structure is aging and the average life expectancy is also increasing. The prevalence of chronic disease and multiple chronic conditions has increased in the past decades. The Health authorities have introduced several models to promote family doctor system or integrated care in hospital outpatient departments. However, the effects seemed to be minimal and more advanced care model should be considered to meet the medical needs of the growing patients with chronic diseases and multiple chronic conditions.
Objective: This study was to understand patients’ ambulatory care choice with a high degree of freedom to access to health care provider in Taiwan. This study aimed to investigate whether the patients’ choice to visit a doctor at a big-hospital would change because of the increased number of chronic disease, and to know whether the increased number of chronic conditions and the changes in patients’ choice would affect the patients’ health care utilization and health care outcome.
Methods: Patients with one of the 4 common chronic conditions in 2006 in the National Health Insurance Research Database was selected as the objects of this study. This study tracked the changes in the number of chronic conditions in 2006-2011, and used the percentage of outpatient visits in big-hospitals as the index for the patients’ choice. This research also managed to transform the percentage into an ordinal variable as high, median and low rates. The analysis model used in this study included ordinal logistic regression model, log-linear model and negative binomial regression model.
Result: The increased number of chronic conditions resulted in a higher probability of big-hospital visits as well as a higher numbers of outpatient visits, hospital admission, and avoidable hospitalization. The higher percentage of big-hospital outpatient visits was associated with fewer outpatient visits more hospital admission and avoidable hospitalization.
Conclusion: The increased number of chronic conditions would lead to a higher probability of visiting doctors at a big-hospital as well as more outpatient visits and hospital admission. The results also showed that patient who visited doctors at a big-hospital did not receive a better outpatient service. The reason might be the lack of information and control on disease severity. In order to implement the referral system in the NHI, and to improve the Taiwan chronic care system, policy maker should take the increased number of chronic conditions into account in the future, and also study more on provider selection. As for the comparison of health care outcome among patients with different provider preference, future researchers should include clinical data to control disease severity.
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