Sanchong City Public Health Center

MD, MSc, PhD candidate1How to develop the primary care system in each country And to develop the PHC, we need to consider both the quantity and qualityThat means not only the numbers should increase, so are the services.In the next 15mins, I am going to show you the trend in Taiwans PHC development which is not only growth in numbers but with the implementation of CHCG program, the quality of health care is ensured as well.1921

22,300 deaths and 8,000 injured. After that, the government was aware of the importance of development of primary care.In 2003,., though there were more clinics in the community, they do not work as a group or collaborate with hospitals, and they do not have the ability to control transmitted disease and can not coordinate with the public health bureau

23 ?Community citizensMedical centersRegional and community hospitalsPHCMedical centersRegional and community hospitalsPHCThe triangle should be upright.3

TaipeiTaoyuanTaichungKaohsiungTainanHualien

Changhua

5Reconstruction of primary care system was vital to improve health in the community6 Models of integrated care system in the communityDisease care, case management, family health record67A government project since 20035~10 GPs, one fifth of which specialized in FMRecruit members from patients encounteredContinuous and comprehensive care24call centerRegular meeting and sharing experiences8Department of Health, Taiwan, 2003Due to such problems in PHC, the government granted a project called A CHCG was composed of Any patient who is willing to become the membership of the health group, just sign a contract for free. Whole family can join together. But each one person can choose one health care group

8 Virtual Capital Actual Expense24 The fee-for service payment was not effected whether join this program or not

9And of course there has to be some incentives for GPs to participate in the projectAnnual reimbursement was up to US $ 70,000IT setting and electronic health record 9

1011

12

132011-

14

2010

+16.88%2+5.18%15(2006-2008) 12%

16. 2010

P. 56 ~ 60.

2010

Lower ER and admission rate24-hr consultationPatient satisfaction182013102196550(24): 90%+: 90%+H1N1 21In Taipei, 284 clinics worked with 12 public health center and 1 local health bureau to prevent virus transmission.

Individuals were able to reach one clinic in 8-minute distance**98H1N1 Enterovirus oral screeningCancer screeningSmoking cessationWeight controlVaccinationAnd more..

22Once the network was set, all you have to do is to think of something that you want to promote. And put it to the system.22441023742,78527.73%3,3431261938.28%= 60 :40 75:2525%$6155000~1000 50025-304000~6000100

Pay for reportPay for performance981.4(1)

(2)(3)(4)5()(6)

(7)(health outcome)(8)

(9)(10)

921WHO

4445

WHO: World Health Report, 2008This is an ideal model of health delivery, and this is how we have tried to done in the past 10 years. But before I explained how we make this work, I have to give you some background about Taiwans health system, especially the national health insurance.4546Thank you for yourattention

Chart10.16520.06140.08410.17350.29420.0830.03130.01540.0919

8.41%29.42%9.19%

2010() ()Title: health protection between enrollees and non-enrollees (2008)(periodic health exam ratepap smear rateenrolleesnon-enrollees()201051.80%33.69%51.80%33.69%34.92%28.51%34.92%28.51%

2010() ()

periodic health exam rate51.8%

2010()

pap smear rate33.69%28.51%

2011 ()Title: health protection between enrollees and non-enrollees (2008)(periodic health exam ratepap smear rateenrolleesnon-enrollees()2010enrollees51.80%enrollees33.69%51.80%33.69%non-enrollees34.92%non-enrollees28.51%34.92%28.51%

2011 ()

exam rateperiodic health exam rate51.8%

2011

exam ratepap smear rate33.69%28.51%

84-99 (5)Title: Distribution of specialties in 2010 CHCGs()Internal medicinesurgeonObs/GynPediatricsFamily medicineENTOphthalmologyOrthopedics16.52%Others6.14%8.41%17.35%29.42%8.30%3.13%1.54%9.19%

84-99 (5)

8.41%29.42%9.19%

75-99 (2)Title: Distribution of specialties in 2010 CHCGs()Internal medicinesurgeonObs/GynPediatricsFamily medicineENTOphthalmologyOrthopedicsInternal medicine16.52%Otherssurgeon6.14%Obs/Gyn8.41%Pediatrics17.35%Family medicine29.42%ENT8.30%Ophthalmology3.13%Orthopedics1.54%Others9.19%

75-99 (2)

Obs/Gys8.41%Family medicine 29.42%Others9.19%

95-99ClinicsHospitals19958,68078720009,40266920059,948556201010,599508

95-99

&APage &PClinicsHospitalsNumber of ClinicNmuber of hospital

95-99ClinicsHospitals19866,91183519886,97591319907,22382719927,94882219948,51182819969,00977319989,47371920009,40266920029,28761020049,819590200610,064547200810,326515201010,599508

95-99

&APage &PClinicsHospitalsNumber of ClinicNmuber of hospital

2010In ClinicsIn Hospitals200613,1084,2439,07721,756200713,4004,3729,37222,415200813,7374,5739,67223,362200913,9234,7219,89323,918201014,3804,77110,14724,469

2010

&APage &PIn ClinicsIn HospitalsIn ClinicsIn Hostpital

Sheet2ClinicsHospitals200610,0646,0653,006547200710,1976,1043,069530200810,3266,1733,160515200910,3616,2143,217514201010,5996,2953,289508

Sheet2

&APage &PClinicsHospitalsNumber of ClinicNmuber of hospital

12006$34,8642007$35,8152008$37,0992009$37,8412010$38,8492006$10,0642007$10,1972008$10,3262009$10,3612010$10,5992010Internal medicine11.77%11.77%surgeon5.35%5.35%Obs/Gyn6.63%6.63%Pediatrics10.92%10.92%Family medicine11.41%11.41%ENT7.12%7.12%Ophthalmology5.23%5.23%Orthopedics3.40%3.40%GP19.05%19.05%Others19.11%19.11%2010GP357224.54%Family medicine179412.33%Internal medicine203613.99%surgeon5984.11%Obs/Gyn9746.69%Pediatrics147110.11%ENT14349.85%Ophthalmology9586.58%Orthopedics2341.61%Others148210.18%14553100.00% () $256$137$240$542$349$515$257$189$194$67$142$56$149$47$3,130$6,519$3,389Internal medicine$1,93411.77%surgeon$8795.35%Obs/Gyn$1,0906.63%Pediatrics$1,79410.92%Family medicine$1,87411.41%ENT$1,1707.12%Ophthalmology$8595.23%Orthopedics$5593.40%$3,13019.05%Others$3,14019.11%$16,429Internal medicine16.52%surgeon6.14%Obs/Gyn8.41%Pediatrics17.35%Family medicine29.42%ENT8.30%Ophthalmology3.13%Orthopedics1.54%Others9.19%

1

Sheet3

Chart10.5180.3492

51.8%

2010() ()Title: health protection between enrollees and non-enrollees (2008)(periodic health exam ratepap smear rateenrolleesnon-enrollees()201051.80%33.69%51.80%33.69%34.92%28.51%34.92%28.51%

2010() ()

periodic health exam rate51.8%

2010()

pap smear rate33.69%28.51%

2010Title: health protection between enrollees and non-enrollees (2008)(periodic health exam ratepap smear rateenrolleesnon-enrollees()2010enrollees51.80%enrollees33.69%51.80%33.69%non-enrollees34.92%non-enrollees28.51%34.92%28.51%

2010

exam rateperiodic health exam rate51.8%

84-99 (5)

exam ratepap smear rate33.69%28.51%

75-99 (2)Title: Distribution of specialties in 2010 CHCGs()Internal medicinesurgeonObs/GynPediatricsFamily medicineENTOphthalmologyOrthopedicsInternal medicine16.38%Otherssurgeon6.64%Obs/Gyn7.86%Pediatrics16.19%Family medicine29.07%ENT8.12%Ophthalmology3.28%Orthopedics1.66%Others10.80%

75-99 (2)

Distribution of specialties in 2010 CHCGs

95-99ClinicsHospitals19958,68078720009,40266920059,948556201010,599508

95-99

&APage &PClinicsHospitalsNumber of ClinicNmuber of hospital

95-99ClinicsHospitals19866,91183519886,97591319907,22382719927,94882219948,51182819969,00977319989,47371920009,40266920029,28761020049,819590200610,064547200810,326515201010,599508

95-99

&APage &PClinicsHospitalsNumber of ClinicNmuber of hospital

2010In ClinicsIn Hospitals200613,1084,2439,07721,756200713,4004,3729,37222,415200813,7374,5739,67223,362200913,9234,7219,89323,918201014,3804,77110,14724,469

2010

&APage &PIn ClinicsIn HospitalsIn ClinicsIn Hostpital

Sheet2ClinicsHospitals200610,0646,0653,006547200710,1976,1043,069530200810,3266,1733,160515200910,3616,2143,217514201010,5996,2953,289508

Sheet2

&APage &PClinicsHospitalsNumber of ClinicNmuber of hospital

12006$34,8642007$35,8152008$37,0992009$37,8412010$38,8492006$10,0642007$10,1972008$10,3262009$10,3612010$10,5992010Internal medicine11.77%11.77%surgeon5.35%5.35%Obs/Gyn6.63%6.63%Pediatrics10.92%10.92%Family medicine11.41%11.41%ENT7.12%7.12%Ophthalmology5.23%5.23%Orthopedics3.40%3.40%GP19.05%19.05%Others19.11%19.11%2010GP357224.54%Family medicine179412.33%Internal medicine203613.99%surgeon5984.11%Obs/Gyn9746.69%Pediatrics147110.11%ENT14349.85%Ophthalmology9586.58%Orthopedics2341.61%Others148210.18%14553100.00% () $256$137$240$542$349$515$257$189$194$67$142$56$149$47$3,130$6,519$3,389Internal medicine$1,93411.77%surgeon$8795.35%Obs/Gyn$1,0906.63%Pediatrics$1,79410.92%Family medicine$1,87411.41%ENT$1,1707.12%Ophthalmology$8595.23%Orthopedics$5593.40%$3,13019.05%Others$3,14019.11%$16,429Internal medicine16.52%surgeon6.14%Obs/Gyn8.41%Pediatrics17.35%Family medicine29.42%ENT8.30%Ophthalmology3.13%Orthopedics1.54%Others9.19%

1

Sheet3

Chart10.33690.2851

33.69%28.51%

2010() ()Title: health protection between enrollees and non-enrollees (2008)(periodic health exam ratepap smear rateenrolleesnon-enrollees()201051.80%33.69%51.80%33.69%34.92%28.51%34.92%28.51%

2010() ()

periodic health exam rate51.8%

2010()

pap smear rate33.69%28.51%

2010Title: health protection between enrollees and non-enrollees (2008)(periodic health exam ratepap smear rateenrolleesnon-enrollees()2010enrollees51.80%enrollees33.69%51.80%33.69%non-enrollees34.92%non-enrollees28.51%34.92%28.51%

2010

exam rateperiodic health exam rate51.8%

84-99 (5)

exam ratepap smear rate33.69%28.51%

75-99 (2)Title: Distribution of specialties in 2010 CHCGs()Internal medicinesurgeonObs/GynPediatricsFamily medicineENTOphthalmologyOrthopedicsInternal medicine16.38%Otherssurgeon6.64%Obs/Gyn7.86%Pediatrics16.19%Family medicine29.07%ENT8.12%Ophthalmology3.28%Orthopedics1.66%Others10.80%

75-99 (2)

Distribution of specialties in 2010 CHCGs

95-99ClinicsHospitals19958,68078720009,40266920059,948556201010,599508

95-99

&APage &PClinicsHospitalsNumber of ClinicNmuber of hospital

95-99ClinicsHospitals19866,91183519886,97591319907,22382719927,94882219948,51182819969,00977319989,47371920009,40266920029,28761020049,819590200610,064547200810,326515201010,599508

95-99

&APage &PClinicsHospitalsNumber of ClinicNmuber of hospital

2010In ClinicsIn Hospitals200613,1084,2439,07721,756200713,4004,3729,37222,415200813,7374,5739,67223,362200913,9234,7219,89323,918201014,3804,77110,14724,469

2010

&APage &PIn ClinicsIn HospitalsIn ClinicsIn Hostpital

Sheet2ClinicsHospitals200610,0646,0653,006547200710,1976,1043,069530200810,3266,1733,160515200910,3616,2143,217514201010,5996,2953,289508

Sheet2

&APage &PClinicsHospitalsNumber of ClinicNmuber of hospital

12006$34,8642007$35,8152008$37,0992009$37,8412010$38,8492006$10,0642007$10,1972008$10,3262009$10,3612010$10,5992010Internal medicine11.77%11.77%surgeon5.35%5.35%Obs/Gyn6.63%6.63%Pediatrics10.92%10.92%Family medicine11.41%11.41%ENT7.12%7.12%Ophthalmology5.23%5.23%Orthopedics3.40%3.40%GP19.05%19.05%Others19.11%19.11%2010GP357224.54%Family medicine179412.33%Internal medicine203613.99%surgeon5984.11%Obs/Gyn9746.69%Pediatrics147110.11%ENT14349.85%Ophthalmology9586.58%Orthopedics2341.61%Others148210.18%14553100.00% () $256$137$240$542$349$515$257$189$194$67$142$56$149$47$3,130$6,519$3,389Internal medicine$1,93411.77%surgeon$8795.35%Obs/Gyn$1,0906.63%Pediatrics$1,79410.92%Family medicine$1,87411.41%ENT$1,1707.12%Ophthalmology$8595.23%Orthopedics$5593.40%$3,13019.05%Others$3,14019.11%$16,429Internal medicine16.52%surgeon6.14%Obs/Gyn8.41%Pediatrics17.35%Family medicine29.42%ENT8.30%Ophthalmology3.13%Orthopedics1.54%Others9.19%

1

Sheet3