女性經痛中西醫醫療利用之探討

The Medical Utilization of Chinese and Western Medicine in Females with Dysmenorrhea

黃蘭媖(Lan-Yin Huang)

指導教授 ： 張永源

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2012年)

https://doi.org/10.6832/KMU.2012.00095

摘要

研究目的
一、 比較台灣地區經痛婦女不同基本屬性對中西醫就醫次數、醫療費用之醫療利用差異。
二、 探討台灣地區經痛婦女不同基本屬性對選擇中西醫醫療模式之影響。
三、 比較台灣地區經痛婦女不同醫療屬性對中西醫就醫次數、醫療費用之醫療利用差異。
四、 探討台灣地區經痛婦女不同醫療屬性對選擇中西醫醫療模式之影響。
五、 探討台灣地區經痛婦女基本資料、醫療屬性預測醫療利用、醫療模式之情形。
研究方法
本研究樣本取自於台灣國衛院全民健保資料庫2000年承保資料歸人檔(20萬人)中的2008年痛經女性(ICD-9-CM為625.3)就醫資料，研究對象年齡限制在13歲至55歲之間，在排除急診、住院資料後針對不同基本屬性及醫療屬性進行統計分析。
結 果
本研究之有限樣本為4855人次，研究結果顯示台灣地區在2008年間年齡層13-19歲和19-45歲女性因痛經就醫者大部分選擇中醫 (75.2%，63.3%)，而在45-55歲則選擇西醫醫療為多(51.6%)；而各年齡層的醫療選擇方面，13-19歲女性多數僅單純選擇中醫醫療(59.1%)，19-45歲女性則單純選擇中醫或西醫醫療者約各佔一半(45.8%，49.4%)，45-55歲女性則以單純西醫就醫為多(61.3%)。在醫療費用方面，中西醫療皆是除醫學中心外，其他特約類別以45-55歲該族群最高，並與其他年齡層在統計上有顯著差異。中區分局相較於其他分局使用中醫醫療人次和醫療選擇僅看中醫者的比例最高(72.6%，56.8%)。而在人口密度分佈上，居住於低人口密度地區女性較多選擇西醫經痛治療，而居住在人口密度中等及人口密度高地區，則多數選擇中醫醫療。另，選擇醫療院所就醫者，多數為西醫醫療(56.23%)；而選擇在基層診所就醫者，則為中醫醫療比例較高(69.38%)。在醫師性別方面，不論中醫或西醫醫療，選擇男性醫師比例較高(59.4%，76.9%)；但無論中西醫及特約類別，女性醫師所支出的醫療費用大部份皆高於男性，並有統計上的顯著差異。
結論與建議
本研究結果發現，隨著年齡變化，選擇中西醫醫療比例消長與醫療費用呈現正相關，其原因可能為年輕女性偏向原發性經痛，而年紀較長者則為續發性經痛導致。而中區業務組別中，選擇中醫治療者比例偏高，則可能是因為中部地區之中醫教學資源豐富所致。而雖然因經痛選擇男性醫師比例較高，但女性醫師之醫療耗用較男性醫師多，可能由於女性之間相互信任程度較高，患者較容易接受進一步檢查。本研究結果推估醫療費用非影響選擇中西醫的主要因子，也解釋經痛選擇中醫治療比例遠高於其他國家之原因。
建 議
1. 隨著年齡的增加經痛的醫療耗用也增加，應重視女性之情緒與健康議題。
2. 中區分局相較於其他分局使用中醫醫療人次和醫療選擇僅看中醫者的比例最高，應審慎規劃中醫醫療人力分配，以解決中區中醫師密度過高之現況。
3. 在經痛這個疾病別上女性醫師之醫療耗用較男性醫師多，並有統計上的顯著差異。可深究女性醫師在其他疾病別上的醫療耗用是否也有差異。
4. 建議增加Quality of Life問卷，反映經痛症狀隨著醫療使用前後是否使得生活品質變化，並可評估其效益。
5. 未來可以收集月經態度問卷(Menstrual attitude questionnaire) ，以了解台灣女性在面對月經態度正向與否是否與其醫療選擇相關，並可進一步探討經痛所帶來的身心影響，藉此可藉由改變其身心健康進而協助紓緩經痛所帶來之困擾。

關鍵字

經痛 ； 中醫 ； 西醫 ； 醫療利用

並列摘要

The research subjects of this study are women in Taiwan who suffer from dysmenorrhea. The purposes of this study are as follows:
1. Based on their different basic attributes, to compare the difference between Chinese and Western medical utilities, such as outpatient visits and medical payments.
2. To explore what influences their different basic attributes have on seeking for Chinese or Western treatment patterns.
3. Based on their different medical attributes, to compare the difference between Chinese and Western medical utilities, such as outpatient visits and medical payments.
4. To explore what influences their different medical attributes have on seeking for Chinese or Western treatment patterns.
5. In the light of their basic information and medical attributes, try to predict the circumstances of their medical utilization and medical treatment patterns.
Research Methods
The research subjects are the women with dysmenorrhea(ICD-9-CM: 625.3), aged from 13 to 55 years old. Samples were taken from the Taiwan Longitudinal Health Insurance Database 2000(a total of 20 thousand people). We exclude the information of emergency and inpatient treatment cases at the beginning, and then focus on their different basic and medical attributes for proceeding statistical analysis.
Research results
The limited samples of this study are 4855 cases. First, according to the 2008 medical records, woman aged from 13-19 years old and 19-45 years old will seek for Chinese medicine treatment when suffering from dysmenorrhea(the ratio is respectively 75.2% and 63.3%). However, women aged from 45-55 years old will mostly seek for Western medicine treatment (51.6%).
Secondly, when it comes to the treatment choices at different age levels, results show that most of the women aged from 13-19 years old will simply seek for Chinese medicine treatments (59.1%). As for women aged from 19-45 years old, the proportion between simply seeking for Chinese or Western medicine treatment is about half and half(45.8% and 49.4%); women aged from 19-45 years old will seek for Western medicine treatment mostly(61.3%).
Thirdly, when talking about medical payment, except the payment for medical centers, we find that in NHI-contracted clinics, whether it is Chinese or Western medicine clinic, women aged from 45-55 years old pay the most, and the data shows statistically significant difference between this age group and others. Furthermore, comparing to other region branches of Bureau of National Health Insurance, the proportions of the central branch about patients seeking for Chinese medicine treatments and simply seeking for Chinese medicine treatments are the highest(72.6% and 56.8%).
Fourth, if we use population density for analysis index, we can find that in the areas of low population density, most women who suffer from dysmenorrhea will seek for western medicine treatments; in the areas of mid and high population density, most women will seek for Chinese medicine treatments. Besides, about the difference between hospitals and clinics, we find that when they go the hospital, they are mainly for Western medical advices (56.23%); on the contrary, when they go to the clinic, it means they want to seek for Chinese medicine treatments (69.38%).
Finally, as for the gender of the physician, whether it is Chinese or Western medicine treatments, most women will choose male physicians than female physicians (59.4% and 76.9%). However, by all accounts, female physicians’ medical expenses are more than male physicians’ and show statistically significant differences.
Conclusion and Suggestions
Research results show that as age changes, the ratio of seeking for Chinese or Western medicine treatment is positively correlated with medical payments. The reasons may be as follows: on the one hand, the young women tend to suffer from primary dysmenorrhea; on the other hand, the elder women tend to suffer from secondary dysmenorrhea.
According to the medical record of the NHI Central Branch, we find that the ratio of women who seek for Chinese medicine treatment is higher; maybe it is because that there are lots of Chinese medicine resources in central Taiwan.
Although most women choose male physicians than female physicians, female physicians consume more medical resources, resulted from the closer trust relationship between female physicians and women patients. Because of this kind of relationship, women patients are more willing to do further physical examinations. Derived from the research results, we consider that the medical payment is not the main element of seeking for Chinese or Western medicine treatments. Furthermore, comparing to other countries, the results also explain why women in Taiwan tend to seek for Chinese medicine treatment than Western medicine treatment.
Suggestions
1. Since most women use more medical resources for alleviating dysmenorrhea as they get older, the issues of women's emotion and healthy problems should be taken more seriously.
2. Comparing to other NHI branches, the medical records of the NHI Central Branch show the number of people seeking for Chinese medicine treatment and the ratio of patients who simply seek for Chinese medicine treatment are the highest. It seems that the manpower distribution of Chinese medicine resources should be planned more carefully to resolve the situation of high density of Chinese medicine physicians in Central Taiwan.
3. We find that female physicians consume more medical resources than male physicians on curing dysmenorrhea, and results also show the statistically significant difference. As a result, we can also further discuss the differences of their medical resource expensing on other diseases and symptoms.
4. We may collect the Quality of Life questionnaire to reflect the changes between before and after the medical use in dysmenorrhea.
5. We can further collect Menstrual attitude questionnaire to understand the menstrual attitude of women in Taiwan and investigate physical and psychological impact

並列關鍵字

Dysmenorrhea ； Chinese medicine ； Western medicine ； Medical utilities

參考文獻

1. Hillen, T.I., et al., Primary dysmenorrhea in young Western Australian women: prevalence, impact, and knowledge of treatment. J Adolesc Health, 1999. 25(1): p. 40-5.

2. Chantay, B., C., M.R. Chacko, and S.H. Kelder, Prevalence and impact of dysmenorrhea on Hispanic female adolescents. Arch Pediatr Adolesc Med, 2000. 154(12): p. 1226-9.

3. Chen, C., et al., Prospective study of exposure to environmental tobacco smoke and dysmenorrhea. Environ Health Perspect, 2000. 108(11): p. 1019-22.

4. 謝金杏, 青少女痛經自我照顧行為量表之發展與測試. 2001.

5. Robert W. Shaw, C., MBChB, MD, FRCOG, FRCS(Ed), FRANZCOG(Hon), FACOG(Hon,) FRCPI(Hon), David Luesley and Ash K. Monga, BM, BS, FRCOG Gynaecology, 4th Edition. 2011, UK: Churchill Livingstone