Pediatricians' role in caring for preschool children in Taiwan under the national health insurance program.

Background/purpose: The National Health Insurance (NHI) covers more than 98% of the 22 million people in Taiwan. Referral is not mandated, therefore, competition among specialties exists in caring for preschool children. The aim of this study was to analyze the utility of outpatient services among preschool children to investigate the pediatricians role in their care. We also analyzed how the density of specialists induces demand by using the NHI database.
Methods: We used the systematic sampling file, CD20040, from the bureau of NHI, Taiwan, as the data source for our analysis. We linked the file to the registries for medical personnel and the board-certified specialists to analyze the specialty distribution. We also linked to the registry for contracted medical facilities to analyze the distribution in different levels of hospitals.
Results: In total, 56,144 outpatient visits for preschool children were analyzed. Among these, 59.1% of outpatient services for preschool children were provided by pediatric specialists, 20.7% by otolaryngologists, 13.5% by family medicine specialists, and the other 6.7% by general practitioners. Most of the visits occurred in a primary care setting (84.1%). As children grew older, a significant decline in the pediatric specialists visit rate and an increase in the otolaryngologists visit rate were observed in the primary care setting. Young children visited pediatric specialists more frequently. The pediatric specialists visit rate was higher in the northern urban areas. It was also significantly correlated with the density of pediatricians.
Conclusion: Otolaryngologists compete with pediatricians in the primary care of preschool children in Taiwan. The proportion of visits to pediatric specialists was correlated significantly with the density of pediatricians in different counties. The NHI should modify its policy to make the medical system more equitable.