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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 &lt; 0.001). Regarding the effects on healthcare-seeking behavior, there were significant differences from persons aged 40-49 years ( p &lt; 0.1), in junior high school ( p &lt; 0.05), not aware of the policy ( p &lt; 0.001), and awareness of both the hierarchical medical system and the policy to reduce outpatient visits to large hospitals ( p &lt; 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.

international journal of environmental  research and public health/international journal of environmental research and public health

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