Lin Chin-Shien, Khan Haider, Chang Ruei-Yuan, Liao Wei-Chih, Chen Yi-Hsin, Huang Bo-Lin, Hsieh Teng-Fu
Department of Business Administration, National Chung Hsing University, Taichung, Taiwan.
Josef Korbel School of International Studies, University of Denver, Denver, CO.
Medicine (Baltimore). 2020 Aug 7;99(32):e21495. doi: 10.1097/MD.0000000000021495.
The aim of this study was to clarify the relationship between doctor-shopping behavior and clinical conditions, and to clearly outline the effects of both the number of clinic visits and the number of doctor changes on patients' health conditions. Data from January 1, 2000 to December 31, 2004 was collected from the National Health Insurance Research Database in Taiwan. After randomly selecting one million people, we extracted 5-year longitudinal data, about the number of clinic visits, number of doctor changes, and changes in self-health status for each patient with diabetes over the age of 18. We developed a relationship among the variables by using the generalized estimating equation. The results revealed that the number of clinic visits on the change of health status is a U curve, suggesting that health condition could be optimal with an appropriate number of clinic visits. The effect of the number of doctor changes is linearly correlated with health deterioration. The results suggest that disease conditions can only be controlled with an adequate number of clinic visits. Excessively frequent clinic visits are not only unfavorable to patients' health status but are also wasteful of limited medical resources. For diabetic mellitus patients, the more they change doctors, the worse their health status. All of these results are important for patients to stay healthy and to save medical resources.
本研究的目的是阐明“看病找多个医生”行为与临床状况之间的关系，并明确勾勒门诊就诊次数和更换医生次数对患者健康状况的影响。研究数据取自2000年1月1日至2004年12月31日台湾地区的全民健康保险研究数据库。在随机抽取100万人后，我们提取了18岁以上每位糖尿病患者的5年纵向数据，内容包括门诊就诊次数、更换医生次数以及自我健康状况的变化。我们使用广义估计方程建立了各变量之间的关系。结果显示，门诊就诊次数对健康状况变化呈U型曲线，这表明就诊次数适度时健康状况可能最佳。更换医生次数的影响与健康恶化呈线性相关。结果表明，只有通过足够的门诊就诊次数才能控制病情。过于频繁的门诊就诊不仅对患者健康状况不利，还会浪费有限的医疗资源。对于糖尿病患者来说，更换医生越频繁，健康状况就越差。所有这些结果对于患者保持健康和节约医疗资源都很重要。
