Risks and causes of hospitalizations among physicians in Taiwan

Objectives. To assess the causes and cause-specific risks of hospitalization among physicians in Taiwan. Data Sources. The data used in this study were retrieved from filed claims and registries of the National Health Insurance Research Database. A cohort of 33,380 physicians contracted with the national insurance program between 1997 and 2002 were linked to the information on the inpatient claim data for hospitalization. Study Design. The physicians' incidence density of hospitalization was compared with that of the general population, other health personnel, and nurses to compute the calendar year-, age-, and gender-standardized hospitalization ratios (SHRs). A multivariate log-linear model was also used to assess the effects of gender, age, type of contract, and specialty on the risks of hospitalization. Principal Finding. Compared with the general population, physicians experienced significantly reduced risks of all causes (SHR=54.5, 95 percent confidence interval [CI] 53.4-55.5) and all major cause-specific hospitalizations, especially mental disorders (SHR=6.9, 95 percent CI 5.8-8.4). On the other hand, compared with other health personnel, physicians had a small but significantly higher risk of all causes of hospitalization (SHR=107.8, 95 percent CI 105.1-110.6). Higher risks of hospitalization were also noted for neoplasms (SHR=108.9, 95 percent CI 102.0-116.3) and diseases of the respiratory system (SHR=114.2, 95 percent CI 107.3-121.5). In addition to the above diagnoses, physicians also had significantly higher risks for genitourinary and musculoskeletal system and connective tissue problems than nurses. Compared with their physician colleagues, female physicians, young (< 30 years) and older (>= 60 years) physicians, and those working with the health institutions and programs were at elevated risks of hospitalization for all causes as well as for certain specific diseases. Conclusions. Physicians in Taiwan are at higher risks of developing specific diseases compared with their allied health colleagues. As the health of physicians is vital to the quality of care, Taiwanese health policy analysts should recognize that increased patient volume and satisfaction with public health care should not be achieved at the expense of physicians' health.