Abstract
BackgroundHospital admission and emergency department(ED) visits are a massive burden in medical expenditures. In 2003, the Taiwanese government developed Family Physician Integrated Care Program (FPIC) to increase the quality of primary care and decrease medical expenditures. This study’s goals were to determine whether FPIC decreased hospital admissions and ED visits and identify the factors influencing the outcomes.MethodsThis nationwide retrospective cohort study was conducted for the period between 2006 and 2013 by using data obtained from the Taiwan National Health Insurance Research Database. A total of 68,218 individuals were divided into those who joined FPIC and those who did not. We used propensity score matching at a ratio of 1:1 and logistic regression with the generalized estimating equation (GEE) model having a difference-in-difference design to investigate the effects of the FPIC policy on hospital admissions and ED visits in 7 years.ResultsUsing logistic regression with the GEE model with the difference-in-difference design, we found no reduction in ED visits and hospital admissions between the two groups. The participants’ risk of hospital admissions increased in the first year after joining FPIC (OR: 1.11, 95% CI: 1.03–1.20, P < .05). However, participants who joined FPIC showed an 8% lower risk of hospital admissions in the sixth and seventh years after joining FPIC, compared with those who did not join FPIC (OR: 0.92, 95% CI: 0.85–1.00, P < .05).ConclusionsFPIC in Taiwan could not decrease medical utilization initially but might reduce hospital admissions in the long term.
Highlights
Hospital admission and emergency department(ED) visits are a massive burden in medical expenditures
The goals of this study were to determine whether Family Physician Integrated Care Program (FPIC) decreased Emergency department (ED) utilization and hospital admission rates and identify the factors influencing FPIC. Study design This retrospective longitudinal cohort study analyzed data obtained from a secondary database, namely the Taiwan National Health Insurance Research Database (NHIRD), for the period between 2006 and 2013; this database is maintained by the National Health Insurance Administration of Taiwan
The study population comprised more female participants (63.1%) than male participants (36.9%), and 56.23% were aged less than 45 years
Summary
Hospital admission and emergency department(ED) visits are a massive burden in medical expenditures. In 2003, the Taiwanese government developed Family Physician Integrated Care Program (FPIC) to increase the quality of primary care and decrease medical expenditures. This study’s goals were to determine whether FPIC decreased hospital admissions and ED visits and identify the factors influencing the outcomes. Emergency department (ED) utilization plays a vital role in health care expenditure. In 2011, more than 400 ED visits for every 1000 individuals were reported in the population in the United States, indicating the lack of and poor access to community-based primary care [1]. In Taiwan, the ED utilization rate for each person annually was reported to be approximately 18.1%, in which 15 and 20% of ED visits were nonurgent and preventable, respectively, as well [3]. Strategies should be developed to reduce ED utilization and medical expenditures
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