Using Multilevel Analysis to Examine the Doctor Shopping Behavior of Psychiatric Patients and the Association with Their Treatment Outcomes
Date Issued
2012
Date
2012
Author(s)
Chen, Chia-Yu
Abstract
Doctor shopping behavior (DSB) is an important issue of medical care utilization. There are already many studies examined issues related to influencing factors of DSB, but studies on the relationship between DSB and treatment outcome are scant. The objectives of this study were to use multilevel analysis model to examine factors associated with DSB among psychiatric patients and the relationship between DSB and treatment outcome, to fill the research gap.
This study used the 2005 National Health Insurance Registry for Beneficiaries Claims Data covering the years 2006 to 2008. A total of 25,554 psychiatric patients who were older than 18 years of age and visited outpatient and emergency departments for the first time were extracted from the data set. Multilevel regression model were carried out to examine influencing factors of DSB. Logistic regression, Poisson regression, negative binomial regression, and multiple regression models were also used to explore the relationship between DSB and treatment outcome.
The prevalence of DSB was 18.7% in this sample. On the average, a patient had 6 mental illness visits in a year. The results suggested that patients who had heavy mental illness, had chronic disease, aged 18-30 were more likely to have DSB. After controlling for patients characteristics, young doctors and psychiatric doctors were more likely to have DSB patients. However, no significant association was found in the hospital level.
In the medical use, the results showed that having heavy mental illness, having chronic disease, or being male patients were more likely to have medical use. Patients aged 18-30 visited more doctors. Patients aged 41-60 visited more specialties. Doctors aged 45-54, with psychiatric specialty had more patients with frequent visits. Young doctors or emergency doctors had more patients with more attending physician. Patients who lived in central and southern Taiwan, visited private hospitals, or clinic had more visits. Patients who lived in northern and southern Taiwan, visited private hospital and local hospital visited more different doctors. Patient lived in central Taiwan visited more different specialties.
This study also found that patients with DSB were more likely to have bad treatment outcome such as emergency use and hospitalization. The more different doctors and specialties visited, the worse the treatment outcomes. However, patients who had more visits were likely to have better outcome.
The results of the study suggest policy makers can build a better payment system and strengthening the health education for DSB patients. By doing so, the unnecessary use of the medical resources may be reduced, and the continuity of the health care will be better.
Subjects
mental illness
doctor shopping behavior
treatment outcome
multilevel analysis
SDGs
Type
thesis
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