Between professional dignity and economic interests--evidence based on a survey of Taiwan's primary care physicians

Abstract

Objective: If the entirety of professional autonomy must be compromised in the face of a state-run social insurance, physicians may choose to preserve only certain dimensions of their professional autonomy. This study tests the relative importance of the target-income hypothesis versus the professional allegiance hypothesis in explaining physicians' behavior by collating economic interests against professional dignity.

Data and method: A self-administered questionnaire was used to collect the response data from the 1244 physicians who practiced as office-based providers under the contract with the National Health Insurance (NHI) in the South Region of Taiwan and had experienced a change in the utilization review system; 394 (31%) physicians completed the questionnaire. Chi-squared analysis, logistical ordered regression, and odds-ratio analysis were conducted to test the effects of the physicians' experience with the utilization review system on their satisfaction with the NHI program.

Result: The ordered logistical regression verified the hypotheses of physicians' experiences on the satisfaction of the professional-controlled review system, and the odds-ratio analysis suggested that the physicians might give considerable value to their professional dignity. This effect was strong enough to balance out that of the loss in economic interests as the odds ratio was 0.5667 with the 95% confidence interval being (0.1014, 3.1682), which includes the odds ratio of 1.

Conclusion: Economic incentives should not always take center stage if the policy makers are to co-opt physicians. The professional allegiance hypothesis is at work as strongly as the target-income hypothesis.