?The objective of the Medical Care Network Project was to balance the development of medical resources in all regions by setting up regional medical network and hierarchy of medical services. The policy of hierarchical medical care differentiates the roles of different levels of hospitals so that patients can receive appropriate medical treatment. This study aims to examine the effect of the hierarchical medical care policy. We treat the medical care sub-regions as our unit of analysis. Hierarchical multiple regression models were employed to examine the correlation between determinants that including complexity of disease and the proportion of cross-region admission.
??This study was based on the nationwide inpatient information in 2000, provided by the Department of Health. Diseases of secondary care include Pneumonia, Appendectomy, Peptic Ulcer, and Bone Fracture, which can be treated by community hospitals. Diseases of tertiary care include Cancer, Cerebral Vascular Accident (CVA), and Cardiac Catheterization, which should be treated in regional hospitals or hospitals of higher level. The major findings of this study are as follows:
1.In Taiwan, for the year 2000, the proportion of cross-region admission for secondary care is 57.3%+-27.3% in medical care sub-regions, the proportion of cross-region admission for tertiary care is 71.8%+-23.8%.
2.The medical care sub-regions which are more urbanized, more competitive, and having more intensive care units, were evidently lower proportion of cross-region admission.
3.Results from multiple regression analyses show that having hospitals of higher levels will lower the proportion of cross-region admission.
??Based on results of this study, we suggest that we need to improve medical care quality of small community hospitals and establish a workable referral system.
