Effects of Care-Seeking Behavior on Health Service Utilization?A Study Based on Patients with Diabetes in Taiwan

[[abstract]]Diabetes is a common and important problem in terms of clinic and population health. Medical expenditures related to diabetes represent about 10% of expenditures in Taiwan National Health Insurance. The purposes of this research were to analyze health service utilization and outcomes in different medical care seeking behavior. In addition to referring related literatures, the study pays more attention to discuss care-seeking behavior. The independent variable made by investigating the care-seeking behavior of diabetes patients. And construct and compare the path affected models of the purpose toward changes number of complication, severity of disease and usability of resource. The source of the data came from claims data of all set of sampled registry of beneficiaries of National Health Insurance from 1996 to 2003. ICD-9-CM with initial three codes as A181 or 250 were selected from the panel database. Excluded the cases go to the hospital under three times and Retained the cases in 1996 to 2003 have looked examined document. A total of 4694 persons in western medicine, and the cases because the diabetes goes see western medicine have 4669 persons were identified in the final analysis. The major results of this study were as follows: 1. 93.1% of the diabetic patients had readmitted phenomena. 65.1% of the diabetic patients had doctor shopping. 50.3% of the diabetic patients had no continuity of care. 76.8% of the diabetic patients had no regular source of care (RSOC). 91.4% of the diabetic patients had no regular doctor. 2. Total medical expenditure and utilization rate accounted by diabetic care or non-diabetic care outpatient also rise. 3. In emergency and inpatient outcomes were significantly related to the sex, severity of disease and whether or not having major illness. 4. Total medical expenditure of western medicine was significantly related to the severity of disease, whether or not having major illness, doctor shopping and continuity of care. Total medical expenditure of diabetic care were significantly related to age, lower family income, the severity of disease and whether or not having major illness, doctor shopping, continuity of care and regular source of care. 5. Total utilization rate of western medicine was significantly related to sex, age, lower family income, the severity of disease, whether or not having major illness, doctor shopping and regular source of care. Total utilization rate of diabetic care were significantly related to age, the severity of disease and whether or not having major illness and all care-seeking behavior. Based on the results of this study, a few suggestions were proposed as the following: 1. The Bureau of National Health Insurance should set the management of diabetic as the highest priority for the National Health Insurance Family Physician Program 2. To improve the effectiveness of medical services and to control the health care cost, the Bureau of National Health Insurance should encourage patients to establish a regular source of care, regular doctor and continuity of care. 3. To use medical resources more appropriately, the Bureau of National Health Insurance should encourage provider to develop their own case management program. 4. To develop other care outcome index