Investigating the utilization of radiological services by physician patients: a population-based cohort study in Taiwan
1 Institute of Public Health, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Taipei, Taiwan
2 Division of Dermatology, Heping Fuyou Branch, Taipei City Hospital, No. 33, Sec. 2, Chung-Hwa Road, Taipei, Taiwan
3 Department of Education and Research, Taipei City Hospital, No. 145, Zhengzou Road, Taipei, Taiwan
4 Division of Health Policy Research and Development, The Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
5 Institute of Hospital and Health Care Administration, National Yang-Ming University, No. 155, Sec. 2, Li-Nong Street, Taipei, Taiwan
6 Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei 11217, Taiwan
7 National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Taipei, Taiwan
BMC Health Services Research 2013, 13:284 doi:10.1186/1472-6963-13-284Published: 23 July 2013
Advances in radiology technology have contributed to a substantial increase in utilization of radiology services. Physicians, who are well educated in medical matters, would be expected to be knowledgeable about prudent or injudicious use of radiological services. The aim of this study was to evaluate differences in the utilization of radiology modalities among physician and non-physician patients.
This nationwide population-based cohort study was carried out using data obtained from the Taiwan National Insurance Database from 1997 to 2008. Physicians and comparison controls selected by propensity score matching were enrolled in the current study. The claims data of ambulatory care and inpatient discharge records were used to measure the utilization of various radiology modalities. Utilization rates of each modality were compared between physicians and non-physicians, and odds ratios of the utilization of each radiology modality were measured. Multiple logistic regression analysis was used to examine the predictors of X-ray, MRI, and interventional procedures utilization during the study period.
The utilization of most radiologic services increased among physicians and the comparison group during the observation period. Compared to non-physicians, physicians had significantly higher utilization rates of computed tomography and magnetic resonance imaging (MRI) but lower utilization rates of X-rays, sonography, and interventional procedures. After adjusting for age, gender, major diseases, urbanicity, and residential regions, logistic regression analysis showed that, compared to non-physicians, the physicians used significantly more MRI (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.68–2.84, P < 0.001) and significantly less X-rays and interventional procedures (OR: 0.85, 95% CI: 0.72–0.99, P = 0.04 for X-rays and OR: 0.67, 95% CI: 0.54–0.83, P < 0.001 for interventional procedures). Being a physician was a significant predictor of greater usage of MRI and of less usage of X-ray and interventional procedures.
This study revealed different utilization patterns of X-rays, MRI, and interventional procedures between physician and non-physician patients, even after controlling for such factors as socioeconomic status and major diseases.