Risks and Causes of Hospitalizations among Physicians in Taiwan

The health of physicians is vital to the quality of care. Since Duffy and Litin (1964) found in 1964 an elevated risk of psychiatric disorders for physicians, the health among physicians has frequently raised attention, including not only psychological (Stavem, Hofoss, and Aasland 2003) but also physical (Sundquist and Johansson 1999; Stavem et al. 2001) health problems. For a long time, there has been mounting recognition of the fact that practicing medicine can seriously impact a physician's health (Sutherland and Cooper 1993; Caplan 1994; Silvester, Allen, and Withey 1994; Fish and Steinert 1995; Spurgeon, Barwell, and Maxwell 1995). In addition, physicians' heavy workloads might jeopardize the quality of care. It has been reported that higher risks of medical errors (Landrigan et al. 2004), adverse events, and attentional failures (Barger et al. 2006) were observed among interns with frequent extended-duration shifts. Moreover, it is not uncommon for physicians to be reluctant to seek health care from their colleagues through the usual mechanisms. Consequently, physicians may tend to work through illnesses and inappropriately care for themselves, resulting in late presentation with serious illnesses (McKevitt et al. 1997; Clarke, O'Sullivan, and Maguire 1998; Thompson et al. 2001). Since the launch of the National Health Insurance (NHI) program in 1994, the health services industry in Taiwan has changed dramatically. Universal health insurance removed barriers to health care for those newly insured, enabling them more equal access to health care (Cheng and Chiang 1997; Lu and Hsiao 2003). By the end of 2004, more than 98 percent of the Taiwanese people were covered by the insurance program (Division of Health Statistics 2003). Because of the increased demand for health care, the health professionals have encountered heavy workload strains and greater psychosocial demands (Lin, Chang, and Tsai 2004). Taiwanese physicians may experience higher workloads than physicians of Western nations. The number of physicians per 1,000 people in Taiwan was 2.0 in 2003 (Division of Health Statistics 2004), much less than the figures of most nations of the Organization for Economic Cooperation and Development (OECD). Except for Korea, Mexico, and Turkey, which have had fewer than 2 physicians per 1,000 people, the other 27 OECD nations have 2.1 (Japan and Canada) to 4.4 (Greece) physicians (OECD Health Data 2005). Moreover, the provision of universal health care coverage has increased the health care demand (Lu and Hsiao 2003). For example, the number of outpatient visit per person increased from 7.89 in 1992 to 11.46 in 2003 (Department of Health 2003). The annual number of outpatient visits per physician in Taiwan increased to 8,807 in 2003, from only 6,621 in 1992 (Division of Health Statistics 2004), suggesting an increasing heavy workload for physicians in Taiwan. Despite acknowledging the heavy workload among physicians in Taiwan, there are limited studies concerning their health status. Two recent surveys investigated the quality of life of physicians in Taiwan (Lin, Chang, and Tsai 2004; Lee et al. 2005). Based on Karasek's job demand-control model (Karasek et al. 1998), Lin, Chang, and Tsai (2004) reported that approximately 10 percent of the physicians practicing at a medical center in central Taiwan have high-strain jobs. This high-strain group reported a significantly lower quality of life, especially on the psychological scale, compared with the low-strain group. In another study, Lee et al. (2005) reported an inverse relationship between the level of job stress and quality of life among physicians at primary health care centers across the nation. In the present study, we further used the national insurance claim data to examine the risks and causes of hospitalization among physicians in Taiwan.