摘要: | 背景與目的:中醫醫療是華人醫療保健的主要方式之一。台灣中醫自納入全民健保並實施門診總額支付制度後,中醫醫療在衛生政策及健保支付制度上,已成為醫界與學界關心的議題。但台灣中醫醫療利用狀況及其相關因素的探討,仍是衛生政策中較缺乏實證資料與政策應用的研究主題。本研究在探討台灣中醫醫療利用之情形,並評估醫療資源、人口地理社經因子及健康行為等因素之影響。
方法:本研究利用國民健康訪問調查問卷、全民健保資料庫及兩者串檔資料,取得醫療資源、人口地理社經因子及健康行為等變項資料。我們以卡方檢定、t檢定、羅吉斯迴歸及負二項迴歸等方法,分析台灣中醫醫療利用及其影響因素。另外,我們也評估中醫門診總額支付制度實施前後,醫療競爭度的改變對中醫門診醫療利用之影響。
結果:台灣中醫短期(月)醫療利用率為10.4%,性別、年齡、教育程度、婚姻狀態、自覺健康狀況及有無運動習慣等與中醫醫療利用狀況有關。長期(年)醫療利用率為26.6%,影響有無使用中醫醫療利用因子包括性別、年齡、教育程度、職業、平均家庭月收入、是否為原住民、宗教、婚姻狀態、有無使用民俗療法、有無定期健康檢查、有無不健康生活行為、自覺健康狀況、居住地中醫師密度及都市化程度等。在性別差異的分析中,扣除男性與女性的特有疾病後,女性的中醫醫療利用率及就醫次數仍顯著高於男性。不論男性或女性,教育程度、婚姻狀態、有無使用民俗療法、有無定期健康檢查與居住地中醫師密度皆會影響其是否使用中醫門診醫療服務。台灣18歲以上成人32.5%有複向就醫的情形,性別、年齡、教育程度、職業、家庭收入、有無使用民俗療法、居住地中醫師密度及都市化程度等為是否複向就醫的相關因子。本研究發現中醫總額支付制度實施前(1997-1999年),其市場競爭度愈高,民眾的中醫門診就醫費用及就醫次數也愈高;而總額實施後(2000-2005年),相較於低競爭度地區,高競爭度及中等競爭度之中醫門診就醫費用已顯著降低。
結論:醫療資源、民眾的人口地理社經因子及健康行為與台灣中醫門診醫療利用狀況有關,且民眾普遍存在複向就醫行為。此外,中醫醫療市場競爭程度對於醫療服務利用之影響,因中醫門診總額支付制度的實施而有所抑制。
Background and Objectives:Traditional Chinese medicine is one of types of medical care for Chinese population worldwide. After the implementation of National Health Insurance and global budget system for traditional Chinese medicine in Taiwan, traditional Chinese medicine has been a concerned issue of health policy. However, limited information was available on the patterns of utilization of traditional Chinese medicine and associated factors. The objective of this study was to investigate the patterns of utilization of traditional Chinese medicine and medical pluralism in association with medical resources, sociodemographic factors and health behaviors in Taiwan.
Method: This study collected medical records, sociodemographic information and health behaviors from National Health Insurance Interview and National Health Insurance claims data. We estimated the prevalence of short-term and long-term use of traditional Chinese medicine and associated factors. Factors associated with medical pluralism and sex-difference in traditional Chinese medicine use were also investigated in this study. In addition, we assess the impact of the changes of medical competition on utilization of traditional Chinese medicine before and after the implementation of global budget for traditional Chinese medicine.
Results:The prevalence of traditional Chinese medicine within previous one month was 10.4%. Age, sex, education, marital status, self-perceived health status and exercise were factors associated with utilization of traditional Chinese medicine. The prevalence of traditional Chinese medicine within previous one year was 26.6% that associated with age, sex, education, occupation, family income, aborigine, religion, use of folk therapy, regular health examination, unhealthy lifestyle, self-perceived health status, density of traditional Chinese medicine physician, and urbanization. In the sex-difference analysis, the prevalence and the average of frequency for utilization of traditional Chinese medicine were higher in women than in men after excluding sex-specific diseases. Education, marital status, use of folk therapy, regular health examination, and density of traditional Chinese medicine physician were factors associated with utilization of traditional Chinese medicine both in men and women.
In 2001, the prevalence of medical pluralism in people aged 18 years and older was 32.5%. We found that age, sex, education, occupation, family income, use of folk therapy, density of traditional Chinese medicine physician, and urbanization were significant factors associated with medical pluralism. Our study found that before the implementation of global budget for traditional Chinese medicine (between 1997 and 1999), with the increase of market competition, the outpatient medical expenditure and frequency of medical visits for traditional Chinese medicine increased among people in a specific area. After the implementation of global budget for traditional Chinese medicine (between 2000 and 2005), the outpatient medical expenditure was reduced in high-competition area compared with low-competition area.
Conclusion: The one-month and the one-year utilization of traditional Chinese medicine were 10.4% and 26.6%, respectively, and the medical pluralism is common among people in Taiwan. Medical resources, sociodemographic factors, and health behaviors were associated with utilization of traditional Chinese medicine. The implementation of global budget for traditional Chinese medicine restrained the influence of market competition on utilization of traditional Chinese medicine. |