| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 91 === Philosophy of free economy and reevaluation of government’s role gradually encourage privatization trend of public services. Although the National Health Insurance program, implemented in 1995, satisfies a certainly level of medical needs, approximately 4% of the residents in Taiwan are still not enrolled, and the vulnerable sub-populations may still face the uncertainty of medical accessibility. Private hospitals seems to deliver care more efficiently than public hospitals, however, whether private hospitals could fully replace its public counterparts or to allow non-for profit organizations to take over public hospital managements remain under considerable policy debates.
In order to investigate whether public hospitals play a different role from private hospitals, this study used the National Health Insurance Research Database to observe the trends of patient’s hospital choice behavior in Taiwan, and to analyze how hospital choices vary by provider levels, geographic areas, and vulnerable sub-populations between 1996 and 2000. The main results are summarized below：
1. When patients chose higher levels of hospitals, greater proportion of patients went to public hospitals. For ambulatory care visits, 34.4%, 30.8%, and 16% of visits occurred in medical centers, regional hospitals, and district hospitals, respectively. For inpatient admissions, the proportions were 34.7%, 31.5%, and 19.5%.
2. The likelihood of choosing public hospitals varied substantially between counties. The off-shore island residents were most likely to choose public hospitals, the Changhua county residents were least likely to go to public hospitals for care.
3. The socio-economically disadvantaged like the indigent and the unemployed were more likely to choose public hospitals than others. The higher the insurable amount, the higher probability of choosing public hospitals. However, aborigines were less likely to choose public providers than non-aborigines.
4. The health disadvantaged sub-populations such as patients with a major illness preferred to choose public hospitals, in contrast to those without.
5. The medical resources disadvantaged sub-populations like residents in remote areas or areas without sufficient medical resources had no significantly different preference for public hospitals from residents in other areas.
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