OBJECTIVES: Primary care system is responsible for the management and coordination of patient care. Although the government advocates rerouting patients seeking primary care from large hospitals to local clinics, little is known whether the local clinics are more like general (family) practices, or on the contrast, specialized clinics. This study examines how many local clinics are able to take on the functions of primary care providers based on the measure of patient complexity and the services provided by local clinics in Taiwan.

METHODS: The 2009-2013 population-based National Health Insurance database is used in this study. The Patient Complexity Score is defined by the quantity, variability, and diversity of the inputs and outputs in the ambulatory care. In addition, we referenced the quality care indicators commonly used and then summed up eleven primary care services used for measuring their prevalence among local clinics in Taiwan. This study examined the relationships between geographical urbanization and patient complexity and services provided by local clinics.

RESULTS: Among all of the local clinics, 36% are family medicine clinics, 25% and 15% are specialized in internal medicine and pediatric, representatively. Patient Complexity score is the highest for internal medicine providers, followed by family medicine. The results suggest that the common primary care services that primary care clinics can provide are: Fasting blood lipids (42.1%), adult health examination (39.8%), glycosylated hemoglobin test (36.4%), microalbuminuria test (30.5%), elderly influenza vaccine (25.8%), fecal occult blood test (18.7%), pap smears (10.2%). The results of multivariate analyses reveal that the degree of urbanization in the clinics is inversely proportional to Patient Complexity and the ratio of primary care services provided.

CONCLUSIONS: Overall, family medicine and internal medicine clinics in Taiwan act more like primary care providers. Ideally, primary care services should be offered more evenly between providers.