台灣地區中醫傷科與西醫復健科醫療利用情形之探討

Study on Utilization of Traditional Chinese Trauma tologic Manipulation and Rehabilitation Medicine in Taiwan

饒芯萍(rau shin ping)

指導教授 ： 石曜堂

亞洲大學/健康學院/健康管理研究所/碩士(2007年)

摘要

雖然全世界的醫療主流為西醫醫療，但各國的另類療法或傳統中醫療法 已逐漸於各國的醫療體系中扮演重要的角色，且因中醫傷科及西醫復健科門 診具有替代效果，故本研究旨在探討台灣地區民眾利用中醫傷科、西醫復健 科及中西醫併用之門診醫療利用情形及其影響因素，研究資料乃運用財團法 人國家衛生研究院之2004 年全民健康保險研究資料庫之中醫、西醫復健科「門 診處方及治療明細檔」與「醫事機構基本資料檔」、「承保檔」進行串檔與歸 戶，並以T 檢定（T test）及變異數分析（ANOVA）檢定資料耗用之差異，利 用複迴歸統計方法探討其影響因素，同時提出以下三點研究假說： 假說一：不同的民眾個人特質對中醫傷科、西醫復健科及中西醫併用門診之 醫療利用情形有差異。 假說二：不同的民眾疾病狀態對中醫傷科、西醫復健科及中西醫併用門診之 醫療利用情形有差異。 假說三：不同的地區醫療資源對中醫傷科、西醫復健科及中西醫併用門診之 醫療利用情形有差異。 根據研究結果，得知中醫傷科門診之投保身分別、投保金額及中西醫併 用（復健科）門診之性別、投保身分別、慢性病與醫療利用無顯著差異外， 其他變項皆達統計上顯著差異，因此判定假說一、二、三皆成立。 且亦發現重要研究結果如下： ii 一、 研究發現民眾較偏好利用中醫傷科門診，且中醫傷科及西醫復健科門診 具替代效果，而中西醫併用門診則呈現互補及替代關係。 二、 西醫復健科門診之醫療利用明顯高於中醫傷科或中西醫併用門診。 三、 20-49 歲及患有「關節、肌肉扭傷及拉傷」的民眾較傾向利用中醫傷科 門診，40-59 歲、75 歲以上及患有「背部病變」之疾病（如退化性脊椎 炎、椎間盤突出、腰痛、坐骨神經病等）的民眾較傾向利用西醫復健科 門診，40-59 歲及患有「背部病變」之疾病的民眾較傾向中西醫併用， 顯示因民眾基本特性及疾病之不同，其門診利用情形亦不同。 四、 民眾個人特質方面：中醫傷科門診之醫療利用隨著年齡的增加而成長， 西醫復健科門診之醫療利用卻隨年齡的增加呈現J 型曲線。女性利用中 醫傷科及中西醫併用（傷科）門診之醫療利用較高，男性則以利用西醫 復健科及中西醫併用（復健科）門診較高。不論中醫傷科與西醫復健科， 以第五類低收入戶及免部分負擔之醫療利用最多。 五、 民眾疾病狀態：民眾併有慢性病或重大傷病者之醫療利用較高，且因疾 病別不同，醫療利用情形亦有所差異。 六、 地區醫療資源：就院所特約別而言，中醫傷科、西醫復健科及中西醫併 用門診就醫人數皆以於基層院所就醫最多，民眾利用中醫傷科及中西醫 併用（傷科）之門診醫療利用以至地區醫院就醫最多，且研究發現醫療 資源較充足之地區，醫療需求會隨著醫療資源的增加而增加。 iii 七、 整體而言，影響民眾醫療利用之因素為年齡、投保地區、部分負擔、疾 病因素、地區醫療資源。 根據上述研究結果，本研究提出幾點建議，僅供各界參考： 一、 對衛生主管機關之建議： （一） 建議有關單位進行相關實證研究，提供高成本效益之治療方式。 二、 對後續研究者之建議： （一） 納入其他相關變項，以更完整分析醫療利用情形。 （二） 擴大研究範圍，以更深入了解特定族群、疾病特性之醫療利用變 化情形與影響因素。 （三） 納入自費醫療項目，以總體面探討民眾於醫療之花費與利用。

關鍵字

中醫傷科、西醫復健科、另類療法、醫療利用

並列摘要

While the western medical treatment is the main stream in the world, another
alternative one and Chinese traditional one have played important roles
everywhere. Moreover, Chinese traditional traumatologic manipulation can
replace the functions of rehabilitation medicine. The purpose of this study is to
analyze how people use Chinese traditional traumatologic manipulation,
rehabilitation medicine and the treatment of both ways in Taiwan. The data come
from Chinese medicine and rehabilitation medicine files of the National Health
Insurance, released by the National Health Research Institutes in 2004. Statistical
analysis was performed by using the SPSS 13.0 system. The data were analyzed
by using T test and Analysis of Variance (ANOVA). Multiple Regression analysis
was used to explore its related factors.
The hypotheses were as followings:
Hypothesis 1: The demographic characteristics are different among Chinese
traditional traumatologic manipulation, rehabilitation medicine and
integrated treatment.
Hypothesis 2: The disease patterns are different among Chinese traditional
traumatologic manipulation, rehabilitation medicine and integrated
treatment.
Hypothesis 3: The medical resources are different among Chinese traditional
traumatologic manipulation, rehabilitation medicine and integrated
treatment.
The utilization of beneficiary and urbanization level in Chinese traditional
traumatologic manipulation were no significantly difference. Sex, beneficiary,
chronic diseases in integrated treatment were no significantly difference, either.
v
But other factors were. Thus Hypothesis 1, 2 and 3 are established.
The findings were as followings:
1. People showed much favor to use Chinese traditional traumatologic
manipulation. Chinese traditional traumatologic manipulation and rehabilitation
medicine have the substituting effects. And integrated treatment had
complementary and substituting effects, too.
2. However, the utilization rate of rehabilitation medicine was higher than Chinese
traditional traumatologic manipulation and integrated treatment.
3. People who aged 20 to 49 years old, had diseases of “sprains and strains＂
prefer Chinese traditional traumatologic manipulation utilization. People aged
45 to 59 and over 75 years old with diseases of “dorsopahty (disorder of the
back) ＂ would rather to have rehabilitation medicine utilization. And those
who aged 45 to 59 years old with diseases of “dorsopahty (disorder of the
back) ＂use integrated treatment more. The results showed that different
demographic characteristic and disease patterns had difference medical services
utilization.
4. Demographic characteristic: The utilization of Chinese traditional traumatologic
manipulation medical services increased with age; the utilization of
rehabilitation medicine medical services are shown as the “J＂ curve.
Beneficiaries category as category Ⅴ “low income＂and subjects with
waived copayment had higher utilization.
5. Disease patterns: The patients with chronic diseases or major illness had higher
medical services utilization. Thus, different disease had different medical
vi
services utilization.
6. Medical resources: Utilization rate of Chinese traditional traumatologic
manipulation and integrated treatment was higher at local hospitals.
Treatment needs increased as medical resources increased.
7. The related factors of utilization of Chinese traditional traumatologic
manipulation, rehabilitation medicine and integrated treatment were age,
insurance area, copayment, disease patterns and medical resources.
Some suggestions for future studies and policy makers in the government are:
1. Evidence-base medicine and cost-effectiveness studies should be conducted for
further development of Chinese traditional traumatologic manipulation,
rehabilitation medicine and integrated treatment.
2. There should be more other variables to analyze the utilization of Chinese
traditional traumatologic manipulation, rehabilitation medicine and integrated
treatment completely.
3. There should be panel studies to analyze the utilization and to explore its
related factors of characteristics of population at risk and disease patterns.
4. Self-paying of medical treatment should be included to explore the utilization
of medical expenditure.

並列關鍵字

Chinese traditional traumatologic manipulation, rehabilitation medicine, alternative medicine, medical utilization

參考文獻

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