title: Does continuity of care matter in a health care system that lacks referral arrangements?
abstract: BACKGROUND
  Numerous studies have suggested that better continuity of care (COC) can lead to fewer emergency department (ED) visits and fewer hospital admissions. However, these studies were conducted in countries where patients have their own family physician or in countries with referral systems. This study aimed to determine whether the association between lower COC and increased health care utilization may be apparent in a health care system that lacks a family physician or a referral system.
  
  
  METHODS
  The study population included a total of 134 422 subjects who made four or more visits to physicians in 2005. Negative binominal regressions were performed to examine the effects of three different COC indices on the numbers of hospital admissions and ED visits in 2005 and in the subsequent year (2006).
  
  
  RESULTS
  The data suggest that lower COC was associated with increased hospital admissions and ED visits in our study population. Compared with the high COC group, subjects in the low and medium COC groups had 42-82% and 39-46% more hospital admissions, respectively, as well as 75-102% and 41-45% more ED visits, respectively, in 2005. Weaker protective effects of COC were also observed in the subsequent year.
  
  
  CONCLUSIONS
  This study indicates that lower COC is associated with increased hospital admissions and ED visits, even in a health care system that lacks a referral arrangement framework. This suggests that improving the COC is beneficial both for patients and for the health care system.
authors.affiliation: Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC. shcheng@ntu.edu.tw
authors.forename: Shou-Hsia
authors.initials: SH
authors.lastname: Cheng
authors.forename: Yen-Fei
authors.initials: YF
authors.lastname: Hou
authors.forename: Chi-Chen
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012044:Regression Analysis; D013624:Taiwan; D019472:Universal Health Insurance