The Impacts of the Hierarchical Medical System on National Health Insurance on the Resident's Health Seeking Behavior in Taiwan: A Case Study on the Policy to Reduce Hospital Visits

Objective: This study investigated the impacts of the hierarchical medical system under the national health insurance program on residents' healthcare-seeking behavior in Taiwan. Background: Healthcare authorities in Taiwan initiated an allowance reduction for outpatient visits at regional hospitals and higher hierarchical hospitals in 2018. The ultimate goal is to implement a hierarchical medical system to provide residents accessible as well as consistent medical services. Methods: This research was conducted through a questionnaire survey, and data were collected between August and December 2018 from the records of subjects who had recently sought medical attention. A total of 1340 valid questionnaires were returned. Results: A principal finding was that there were significant differences in the knowledge of new policies by age, marital status, annual income, education level, and occupation (p < 0.001). Regarding the effects on healthcare-seeking behavior, there were significant differences from persons aged 40-49 years (p < 0.1), in junior high school (p < 0.05), not aware of the policy (p < 0.001), and awareness of both the hierarchical medical system and the policy to reduce outpatient visits to large hospitals (p < 0.001). Conclusion: The health administration authorities should devote more effort into promoting knowledge of the policy in order to better inform the public about the hierarchical medical system.