The Relationship between Physician Characteristics and Perceived Difficulties in Implementing a Case Payment System in Taiwan

Background and purpose: The shift from a fee-for-service-based to a case- based imbursement system may have implications to cost containment and quality improvement. However, as the likelihood of wide adoption of case payment increases, so does the fear escalate. Numerous barriers for implementing a successful case payment system are associated with physicians' practice behavior. The purpose of this paper is to exploit the relationship between physician characteristics and potential barriers to implementation of a case payment system in Taiwan.
Methods: In this study, a questionnaire, developed by Lin and Amidon, was used. This 22-item questionnaire, using the Likert scale, consists of five dimensions of barriers to the implementation of the case payment system: 1) perceived barriers to compliance, 2) perceived barriers to quality assurance, 3) perceived financial pressure, 4) perceived threats to physician's autonomy, and 5) inadequate allowance for patient severity. The survey was administered to 500 hospital-based physicians between June and July 2000. Multiple regression analysis was performed for each of the five specific barriers, using physician characteristics as exploratory variables.
Results: The perceived barrier to compliance among physicians is significantly related to the number of post-resident practicing years under the National Health Insurance (p=0.0016), number of beds (p=0.0436), and proprietary hospital status (p=0.0046). The perceived financial pressure for physicians is significantly associated with the number of beds (p=0.0337), being a female physician (p=0.0005), and proprietary hospital status (p=0.041).
Conclusions: Identifying physicians who are more likely to perceive bathers with the implementation of the case payment is crucial to the success for health policy changes. Educational intervention is one of the major strategies that can enhance and facilitate physicians' smoothed transition from a fee-for-service-based to case-based reimbursement system.