Changes of private western clinics' group practices in Taiwan: 1998 and 2003

Objective: To profile the practice modes of privately-owned clinics, in particular the average changes in scale and specialty mix, and to analyze factors associated with group practice. Methods: Data from the 1998 (n=8,544) and 2003 (n=8,571) National Health Insurance Research Database were used. Logistic regressions were used to examine whether local population and competition are significantly associated with establishment of group practice. Results: Single practice has been the major mode of practice in Taiwan. However, the proportion of group practice increased from 17% in 1998 to 23% in 2003, along with a slightly larger average scale. Controlling for other factors, greater population, younger population, and higher competition are positively and significantly associated with the probability of group practice. Specialties such as orthopedics, otolaryngology, and ophthalmology are more likely to form group practice than is general medicine. Conclusions: We consider the changes in practice modes as clinics' ways to expand resources and to gain an edge over competitors. Compared to documented willingness as high as 62% to participate in group practice, physicians in Taiwan have yet to transfer that willingness into action. Barriers to group practice still remain.