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Keywords

ambulatory care, cost containment, physician payment, physician satisfaction, universal health insurance

 

Authors

  1. Yeh, Shu-Chuan Jennifer
  2. Wan, Thomas T.H.
  3. Huang, Chia-Hsiung
  4. Lo, Ying-Ying

Abstract

Background: Under the universal health insurance system in Taiwan, policy makers seek new approaches to balance rising costs and quality of care. One policy, Ambulatory Care Reimbursement, enacted in 2001 has effectively reduced patient numbers in clinics by cutting per patient reimbursement when a physician has seen over predetermined number of patients.

 

Purpose: To access the impact of this policy on physician satisfaction in regional hospitals and medical centers (MCs) from the point of view of their medical directors.

 

Methodology: We conducted a cross-sectional survey of medical directors from 25 MCs and 78 regional hospitals in Taiwan. The survey used a 5-point Likert scale to identify both impacts of reduced ambulatory care visits and physician satisfaction. We randomly selected 30% of all medical directors from both types of medical institutions. Of the 248 medical directors contacted, 142 replied. Excluding 5 incomplete responses, our final sample was 137. Response rates were roughly equivalent for MCs (54.67%) and regional hospitals (57.89%).

 

Findings: Medical directors were typically male, aged 45.11 years, worked in MCs (60%), and were general practitioners (43.1%). Multiple regressions associated three independent predictors of physician satisfaction: physician-patient interaction ([beta] = .393, p = .001), mission ([beta] = .351, p = .007), and reduced health care expenditures ([beta] = .179, p = .014). Medical directors more often characterized the regulation of reducing number of visits as a means of encouraging MCs and regional hospitals to improve physician interaction with patients and, thus, associated it with greater patient satisfaction. Generally, directors did not believe that the regulation encouraged patients seeking care at other hospitals or that it resulted in reduced pay to physicians.

 

Practice Implication: Reducing ambulatory care visits has promoted the physician-patient relationship and allowed many physicians attain their medical mission. Such regulation had influence on the physicians' satisfaction.