The Effects of Global Budget System of Primary Care on the Distribution of Primary Physicians in Kao-Ping Areas of Taiwan

Objectives: The distribution of primary physicians influences the equity and accessibility of healthcare for patients. Especially after the implementation of the National Health Insurance program, theoretically, all the population should have the same access to health resources. Previous studies did not conclude consistent findings in whether global budget system could enhance the distributions of health resources. The present study attempts to evaluate the effects of the global budget system of primary care on the equality of primary physicians in Kao-Ping areas. Methods: The study design was retrospective secondary data analysis. Gini coefficient and Kuznets' indicators were used to measure distribution equality of primary physicians among villages and townships in Kao-Ping areas before and after the global budget system of primary care was implemented. Results: As a whole, the declining values of Gini coefficients indicated that the distributions of primary physicians in Kao-Ping areas become more equal after the global budget system. The average value of Gini for primary physician was 0.184 before the global budget system, and changed to 0.174 after the global budget system, which reached the significant level of declining to 0.01. In terms of Kuznets' indicator, however, significant disparities of primary physician were found between the over-served and under-served areas. Conclusions: The global budget system improved the equality of primary physician in Kao-Ping areas. However, it was not extended to the areas where primary physician are relatively least sufficient. The implementation of the global budget system had different impacts on the distribution of primary physicians in different cities/counties. Possible reasons could be the number of population or population density cannot provide strong incentives for primary physicians to practice in remote areas. This research proposes two recommendations to the national health authority: 1. The authority should further understand and determine the distribution of primary physicians in various cities/counties in order to formulate proper policies and modify the payment schedule; 2. The authority should provide support to the townships with under-served and modify the support system for the mountainous and offshore islands in order to effectively narrow the gap of primary physicians between the over-served and under-served areas