Consumer Experience with the Quality of Primary Care: A Comparison between Community and Hospital Settings in Taiwan

Primary Care;Primary Care Assessment Tool (PCAT);Patient Satisfaction;Public Health Studies

Chang, Cheng-ChuanNolan, Marie T. ;

Johns Hopkins University

关键词: Primary Care;    Primary Care Assessment Tool (PCAT);    Patient Satisfaction;    Public Health Studies;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39274/CHANG-DISSERTATION-2014.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Background and motivation: People in Taiwan enjoy universal national health insurance (NHI) which, as of 2011, covered nearly 99 percent of the Taiwanese population. However, the inability of the NHI budget to handle rapidly increasing costs is a major problem. Over-utilization of health care services and the lack of a gatekeeper for accessing primary care have contributed to this cost escalation. Cost escalation is also caused by patients seeking expensive institutional care for every illness experienced. Therefore, one of the policy challenges in Taiwanese healthcare is to shift from hospital-based to community-based primary care (HBPC or CBPC). In order for patients to seek care in community-based settings, however, the quality of services rendered there must be comparable to those given in institutional settings. This study was to assess the quality of primary care rendered at the community setting relative to the hospital setting. Three aims were analyzed and discussed as follows: Aim 1: To examine the factors associated with consumers’ selection of primary care services provided in either community or hospital settings; Aim 2: To compare the quality of primary care provided in community and hospital settings; and Aim 3: To understand consumers’ perspectives on the family-physician model of primary care. Materials and methods: The study population was comprised of Taiwan residents, based on the power analysis, we selected a number of 1,068 subjects, all of whom fulfill the following criteria: aged between 20 and 70 years and insured under the NHI program (National Health Insurance) in Taiwan. Subjects were selected from the eligible population until the number of samples needed for this study is achieved. With this sample size, the sampling error was less than 0.3 percent and had sufficient data for quantitative analysis. The subjects were contacted by telephone and invited to participate in the study. Those who agreed were interviewed regarding the quality of primary care by using the Johns Hopkins’ Primary Care Assessment Tool. Data were collected through telephone interviews. The Survey Research Institute of Hungkuang University was contracted to provide this professional service. The Institute has a track record of securing high response rates (over 90%) in telephone interviews of Taiwanese residents. The planned length of the interview was approximately 20 minutes. An interview guide was developed covering the following topics: consumer demographics, hospital-based primary care profile, community-based primary care profile, primary care quality (PCAT), and healthcare outcome. Results and discussion: More people in Taiwan chose community-based primary care over hospital-based primary care. However, community-based primary care system in Taiwan is far from fulfilling the roles of a high-quality primary care system, and thus needs further efforts from policy makers, providers, and researchers.No disparity in quality was found between CBPC and HBPC, significant differences in primary care domains were identified. HBPC outperformed CBPC in five domains: utilization, ongoing care, Coordination(referrals)s, Coordination Information Systems, and comprehensiveness of services available, while CBPC received higher scores than HBPC in three domains: access, community orientation, and cultural competence. In addition, regional disparities in quality of primary care are significant. The northern part of Taiwan has the worse quality among the four areas in almost all primary care domains as well as overall primary care. This could be due to the specialty concentration in the north where primary care is somewhat neglected. No significant differences in overall patient satisfaction were found between CBPC and HBPC. After controlling for individual socioeconomic characteristics, cultural competence appeared to be the most influential factor on patient satisfaction for both groups.Conclusions: More people in Taiwan chose community-based primary care over hospital-based primary care. However, community-based primary care system in Taiwan is far from fulfilling the roles of a high-quality primary care system, and thus needs further efforts from policy makers, providers, and researchers.