title: Patterns of nonemergent visits to different healthcare facilities on the same day: a nationwide analysis in Taiwan.
abstract: Doctor shopping is a common phenomenon in many countries. However, patterns of switching healthcare facilities on the same day were little known. The data were obtained from the longitudinal cohort datasets (LHID2010) of Taiwan's National Health Insurance Research Database in 2010. Of 1,000,000 persons of the cohort with 13,276,928 nonemergent visits, 185,347 patients had visited different healthcare facilities within one day, with a total of 672,478 visits and 337,260 switches between facilities in 329,073 patient-days. While 63.0% (n = 212,590) of all switches occurred between facilities of the same accreditation level, 14.1% (n = 47,664) moved from lower to higher level, and 22.8% (n = 77,006) moved in the opposite direction. In 33,689 switches, patients moved to the same specialty of another facility. In 48,324 switches, patients moved to another facility with the same diagnosis, and the most frequent diagnoses were diseases of the digestive system (11,148) and diseases of the respiratory system (10,393). In a densely populated country without strict referral regulation, a high percentage of Taiwanese people had the experience of visiting different healthcare facilities on the same day. The system of family physicians as personal doctors and gatekeepers to healthcare might ameliorate the harmful impact.
authors.affiliation: Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
authors.forename: Meng-Hsuan
authors.initials: MH
authors.lastname: Wu
authors.affiliation: Faculty of Medicine, Semmelweis University, Budapest 1094, Hungary.
authors.forename: Meng-Ju
authors.initials: MJ
authors.lastname: Wu
authors.affiliation: Department of Public Finance, National Chengchi University, Taipei 116, Taiwan.
authors.forename: Li-Fang
authors.initials: LF
authors.lastname: Chou
authors.affiliation: Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan ; Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan.
authors.forename: Tzeng-Ji
authors.identifier: 0000-0002-8350-0232
authors.initials: TJ
authors.lastname: Chen
mesh_terms: D015331:Cohort Studies; D005260:Female; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D013624:Taiwan; D014600:Utilization Review