| Summary: | 碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 107 === Background: Taiwan not only lacks a comprehensive family physician system or a role of “gatekeeper”, but also allows people accessing to any medical care provider without being referred. Therefore, the situation leads to the hierarchization of services cannot be implemented. Along with the effectiveness of Family Physician Integrated Care Program is not as good as expected, and the medical system is developing towards the specialization, people usually chooses specialist as their primary care provider. In 2006, the National Health Insurance Administration strengthen the promotion of the Hierarchically Integrated Healthcare System that encourage people to first seek care at primary-level hospitals or clinics. In addition, it expects that people can have a regular source of care or a family physician to take the responsibility for their health. However, is it still presence of primary care in Taiwan? Which types of specialist could be choosing to be a regular source of care provided primary care practice?
Objective: The aims of study are applying the concept of primary care to develop patients’ regular source of care indicators.
Methods: The study used National Health Insurance Research Database from 2007 to 2011 for statistics analysis. The study design is divided into three parts. The first part is developing patients’ regular source of care indicators, including: patient loyalty, the frequency of visit and the proportion of old patient. In the second part, tracking the percentages of primary care diseases in outpatient visits, and used Criterion-related validity to validate the validity. The final part used the receiver operating characteristic curve (ROC curve) to find the optimal threshold of the indicator as the basis for the patients’ regular source of care indicator, and compared the indicators.
Result: The higher percentages of primary care diseases in clinic outpatient visits, with positive correlation in patient loyalty and the proportion of old patient indicators. After excluding the specialists with non-significant correlation coefficient, it can be inferred that people choose Family Medicine, General Internal, Pediatrics, Obstetricians and Gynecologists as their regular source of care. And the lower percentages of primary care diseases in regional hospital and medical center outpatient visits, with negative correlation in three indicators. It can be inferred that types of diseases sought by the regional hospitals and medical center may be severe or difficult. That result in patients needed to revisit frequently.
Conclusion: Although the validity of the three indicators is acceptable, it is enough to correctly distinguish which types of specialist could be choosing to be a regular source of care provided primary care practice. And people would “self-referred” to the tertiary care, when they thought it wasn’t primary care practitioner could help.
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