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Yu Chang, "Variations in physician practice patterns for eye care under the National Health Insurance of Taiwan," 2000

USC dissertation in Strategic Policy Planning.
August 24, 2009

Joanna Chih I Yu Chang, Ph.D

Abstract (Summary)

Taiwan implemented its National Health Insurance program (NHI) in 1995. It covers 20 million people; the enrollment rate is 96%. NHI uses a single-pipe, fee-for-service payment system. All physicians practice at four levels of institutions: medical centers, regional hospitals, district hospitals, and physician offices. NHI has a low co-payment, easy access to all facilities, and no referral system.

Health expenditures grew by more than 10% in each of the past four years while NHI's premium revenues increased 2.36% yearly between 1995 and 1998. The average outpatient visit is 15 per beneficiary per year. In 1998, NHI ran a deficit due to slow reform action and low premium collections.

This dissertation is based on Taiwan's NHI outpatient claim data for calendar year 1997. The analyses are limited to services related to eye care. Differences among physicians in medical care practice patterns have been well documented. Various practice settings, geographic variations, and physician characteristics should explain the treatment and charge variations in addition to the patients' clinical severity and characteristics.

The study's conceptual framework is based on the supplier-induced-demand model, cognitive model, behavioral model, and sociological model. Statistical techniques utilized are paired t test, chi square, and general linear regression. Four components (all eye care study, cataract surgery episode study, physician characteristic study, and physician profiling) comprise the study. The study's purposes are to provide detailed baseline information on utilization and expenses. Additionally, comparative data with other countries have epidemiological, economic values. Application of the findings acknowledges how well NHI meets beneficiaries' needs. In addition, the findings can be applied to policy to control rising health costs through utilization review and physician profiling.

The major findings are (1) The volume of cataract surgery rate matches the WHO' standard. (2) The charge per visit is much higher in medical centers than physician offices after controlling the patients' ages and genders. (3) Region five has highest density of ophthalmologists explaining the high volume of cataract surgery compared to other regions. (4) Male physicians charge 2.8% higher than female physicians.

Advisor: Melnick, Glenn