부산대학교 도서관

Purpose: Starting in 2017, the Ministry of Health and Welfare in Taiwan has been promoting a tiered health care system based on the following six major strategies: (1) Enhancing the capacity of primary care, (2) Encouraging the public to adjust to referral systems and copayments, (3) Increasing payments to hospitals for critical care as an incentive to reduce resources spent on minor illnesses, (4) Strengthening cooperation between hospitals and clinics to ensure care continuity, (5) Promoting health literacy and self-care, and (6) reinforcing the management of medical institutions. This study accordingly aimed to examine physicians' agreement and satisfaction with this policy and compare the differences between the responses of physicians working at clinics and hospitals. The results can be used to help better implement the tiered health care system in Taiwan. Methods: An anonymous questionnaire was issued during the period from March 5 to August 30, 2020 to 354 physicians working at clinics and 157 at hospitals in a county in southern Taiwan. The questionnaire incorporated items on (1) Demographic data, including age, sex, specialty, and worksite, (2) Opinions regarding the tiered health care system, and (3) Levels of agreement and satisfaction with the 24 measures of the 6 strategies for promoting the tiered health care system. An independent samples t test was used to measure the differences between the responses of physicians from clinics and hospitals. Results: A total of 95 valid questionnaires were analyzed, including 63 from clinic physicians and 32 from hospital physicians. In general, physicians' agreement with the policy was higher than their satisfaction with policy implementation (p＜0.001). Compared with hospital physicians, clinic physicians were more satisfied with strategy 2 (p=0.041), agreed more with strategy 3 (p= 0.025) and strategy 6 (p＜0.001). Conclusion: Physicians generally agreed with the policy, but most were less satisfied with its implementation. For successful implementation of the tiered health care, effective measures need to be developed to increase physicians' awareness of relevant policies and to understand and respond to the concerns and difficulties of physicians, such as the establishment of a barrier-free environment at clinics, regulations of holiday hours at clinics, provision of 24-hour on-call service, and problems about down-referral.