The influence of physician and hospital resources on small area variation in acute hospital utilization in the Pingtung region in Taiwan

Expanding utilization is now creating serious economic problems for the Bureau of National Health Insurance (BNHI) which manages the medical system in Taiwan. The BNHI has reported that treatments of inpatients with Major Illness/Injury Certificates (MIIC) raised the cost of the health care management system to 20% of total inpatient health care expenditures in 2001. Problem like cost containment for MIIC patients observed by the BNHI deserves more study.; Health care utilization is the result of the joint influences of providers and consumers. It is expected that many provider characteristics could affect utilization. This study tried to figure out which variables may affect medical care utilization and examined the possibilities for optimizing medical care utilization. In this study, the specific regression, a modified form of multiple regression, was performed for the age-gender group as the unit of analysis on a dependent variable of discharge numbers. A general linear regression was performed for age-gender groups as the unit of analysis on a dependent variable of area standard discharge ratio in order to represent comparisons of discharge ratios.; Significant effects on standardized discharge ratios have been observed for malignant neoplasms. The teaching hospitals or hospitals with a more than average number of clinical units are positively associated with these discharge ratios. Physicians with 2∼4 years of practice compared to those with one year of practice are positively associated with malignant neoplasms age-gender discharges in 1997. Physicians aged 40∼50, or physicians with 2∼4 years of practice compared to one year of practice, are positively associated with malignant neoplasms age-gender discharges in 1999.; This study shows that patients in MCSR1 and MCSR3 are likely to be incurring unnecessary expenses or malpractice risks while others are likely being underserved. Thus, the DOH should fulfill the role of gatekeeper in deciding whether inappropriate utilization came alone with overuse or underuse. For physician recognition of patient concerns, physicians have become gatekeepers for determining appropriate health care.