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APHA Scientific Session and Event Listing

Mei-ling Sheu, PhD, School of Health Care Administration, Taipei Medical University, 250 Wu-Hsin Street, Taipei, Taiwan, 886 2 2736 1661 ext: 3612, mlsheu@tmu.edu.tw and Yue-Chune Lee, DrPH, Institute of Health and Welfare Policy, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Beitou District, Taipei city, Taiwan.

Taiwan's ambulatory care is provided both in clinics and hospitals. Accounting for 66% of the outpatient cases in western medicine, clinic outpatient services in Taiwan are highly accessible with low cost. However, many clinicians see many patients per day and work long hours. Since National Health Insurance (NHI) was implemented in 1995, various policies, especially the global budget system, have great impacts on the development of clinics. This research will focus on the changes in clinician workforce in terms of the distribution of their working days and service volume, in particular, whether or not new clinicians have different practice patterns compared to the old ones. National sample from NHI outpatient claim data in 1997 and 2003 will be used for the analysis. Key dependent variables include clinicians' actual working days per month, number of outpatient cases per working day and total cases per month. Preliminary results using subsample (n=23,002) in Octobers 1997 and 2003 showed many clinicians worked longer than 28 days. Clinicians with shorter working days, fewer outpatient cases per working day and fewer total cases were those who provided more specialized services, joined group practice, practiced also in the hospital sector and worked in Taipei area. Higher proportion of new physicians joined group practice and practiced in the hospital sector. The finding implies NHI payment policies might have helped shape the distribution of clinician workforce toward group practice and joint appointment between clinic and hospital sector.

Learning Objectives:

• Understand the organization of ambulatory care and the practice characteristics of clinicians in Taiwan
• Describe key policy changes in National Health Insurance related to the development of the clinic sector in Taiwan.
• Estimate to what extent the distribution of clinician workforce has changed in terms of clinicians’ actual working days per month, number of outpatient cases per working day and total cases per month.

Keywords: Ambulatory Care, Physicians

Presenting author's disclosure statement:

Not Answered