高雄縣市地區民眾中西醫門診醫療服務利用
及生活品質影響因素探討

研究目的西方生物醫學為目前主流醫學，也是許多民眾普遍的就醫選擇，而高齡人口比例快速成長以及對生活品質的重視，使得中醫漸漸成為醫學發展的新趨勢。由於高雄縣為鄉鎮與高雄市之都會生活型態不同，兩縣市在人口密度及醫療資源上有差異，故本研究主要目的在探討高雄縣市地區民眾對中醫、西醫門診之醫療服務利用情形與健康相關生活品質之影響因素，以及是否有城鄉差異，以提供醫療院所及衛生主管機關等訂定相關醫療服務策略管理之參考。研究方法本研究係以民國90年台灣地區國民健康訪問調查問卷，選取12歲（含）以上之高雄縣民眾共計1,007位，高雄市民眾共計1,082位為主要樣本，以回溯性橫斷式資料進行統計，運用SPSS12.0統計軟體分析工具，進行描述性及推論性比較分析。研究結果樣本平均年齡39.74歲(±17.63)，檢定結果西醫門診次數：高雄縣平均11.60次（±15.40）、高雄市平均11.22次（±14.48），P＝0.564；西醫門診總費用方面：高雄縣平均9,198元（±3,4312）、高雄市平均10,034元（±30,139），P＝0.554；中醫門診次數高雄縣平均1.33次（±3.75）、高雄市平均1.30次（±3.83），P＝0.874；中醫門診總費用高雄縣平均757元（±2,237）、高雄市平均696元（±2,030），P＝0.518，均未達統計上顯著水準，故兩縣市中西醫門診醫療服務利用無差異。年齡、婚姻狀況與中醫及西醫門診次數、中醫及西醫醫療費用，檢定結果均P<0.05有顯著差異。工作狀況及個人收入變項，與西醫門診醫療利用均P<0.05，而與中醫門診醫療利用檢定結果均未達到顯著水準。自覺健康狀態、流行性感冒疫苗預防注射、疾病型態等，檢定結果部份P<0.05。顯示中醫及西醫門診醫療服務利用會因年齡、婚姻狀況等人口特質（傾向因素）、工作狀況及個人收入（能用因素）、自覺健康狀態及疾病（需要因素）不同而有差異。西醫門診醫療服務利用的主要因子是需要因素，例如：自覺健康狀況不好比極好者多7.95次；有心臟病較沒有心臟病者多8.40次；有關節疼痛或僵硬比沒有關節疼痛或僵硬多2.27次，檢定結果均P<0.05。西醫門診總費用檢定結果，自覺健康狀況不好比極好者多14,027元；有心臟病比沒有心臟病多13,657元。中醫門診醫療服務利用的主要因子是傾向因素之性別、年齡，男性較女性中醫門診次數少0.484次；年齡65歲以上較12歲以上-39歲以下少0.651次。在健康相關生活品質方面，傾向因素以年齡，需要因素以自覺健康狀況、中風、關節疼痛為身體層面影響因子。而心理層面影響因子以傾向因素中婚姻狀況達統計上顯著水準；能用因素變項則均未達統計上顯著水準。生活品質八個構面與西醫門診醫療利用均有相關，中醫門診醫療利用僅與身體疼痛有相關。生活品質之身體功能、一般健康、社會功能為中西醫門診醫療服務利用的主要影響因子；而中醫門診醫療利用的主要影響因子為身體疼痛，心理層面則均無顯著。結論和建議近年來交通便利、跨區就業及醫療普及，高雄縣與高雄市兩縣市對中西醫門診醫療服務利用上並無城鄉差異現象，但65歲以上、女性之門診醫療利用高，而自覺健康狀況與慢性疾病為西醫門診醫療利用主要影響因素，且與健康相關生活品質有相關，建議加強衛生教育、高危險群預防保健措施，以及增加社區健康促進活動，提供民眾身體及心理相關資源，以期早期防治、有效使用醫療資源並促健康生活品質。由於中大型醫院陸續附設中醫部門，區域人口結構、疾病型態的變化以及醫療機構的消長，民眾就醫選擇可能亦有改變，建議醫療院所定期分析醫療服務利用的影響因素，有助於提供更適切的醫療服務及強化醫療院所的經營及發展。

關鍵字

醫療服務利用；傳統醫學；另類醫療；生活品質；自覺健康狀況量表(SF-36)

並列摘要

Objective Western biomedicine is the mainstream medicine in the present. It’s also the common choice of medical treatment for, public. Growing of the elderly population rapidly and making a point of quality of life which make the Chinese medicine gradually become a new trend. As for the life style, population density and medical resources between Kaohsiung County and Kaohsiung City are so different, the main purpose of our study is to investigate the effective factors of out-patient utilization and health-related quality of life of the Chinese medicine and Western medicine and compare with urban and rural. Finally, we hope to provide other related medical services strategic management to medical institutes and health authorities. Methods In our study, the data came from the National Health Interview Survey questionnaires in Taiwan in 2001. We selected 12-year-old and older for study samples in Kaohsiung, included rural (n=1,007) and urban (n=1,082). Our study is a cross-sectional study and uses SPSS12.0 for statistical analysis. Results In our study, the average age is 39.74±17.63. For the average out-patient numbers of the Western Medicine, rural is 11.60±15.40 and urban is 11.22± 14.48 (P = 0.564). For the average out-patient cost of the Western medicine, rural is 9,198± 3,4312 and urban is 10,034±30139 (P = 0.554). For the average out-patient numbers of the Chinese medicine, rural is 1.33±3.75 and urban is 1.30±3.83 (P = 0.874). For the average out-patient cost of the Chinese medicine, rural is 757±2,237 and urban is 696±2030 (P = 0.518). No matter the utilization of the Chinese or Western medicine service, there are no differences between urban and rural. Age and marital status can effect the out-patient numbers and cost of the Chinese medicine and the Western medicine (P <0.05). Working conditions, personal income can effect the out-patient utilization of the western medicine (P <0.05), but not significant to the Chinese medicine. Self-report health, prevention of influenza vaccine injection and disease patterns are important factors (P <0.05). It’s means that the demographic characteristics (Predisposing characteristics) such as age and marital status, working conditions and personal income (Enabling resources) and self-report health and disease (Need) will effect the utilization of the Chinese medicine and Western medicine out-patient medical services. Needing factors are the most important factors for the utilization of the Western medicine out-patient medical services. For example, worse self-report health (B=7.95), heart disease (B=8.40), relevant section pain or stiffness (B=2.27) have more service use (P <0.05).For the Western medicine out-patient total cost, worse self-report health (B=14,027) and heart disease (B=13,657) have more expenditure. The gender and age are the main factors for the out-patient utilization of the Chinese medicine. Male is 0.484 times less than female. 65 and older are 0.651 times less than 12-39 old. For the health-related quality of life, the predisposing characteristics such as age, needing factor such as self-report health, stroke and joint pain are effective factors for the physical status. The predisposing characteristics such as marital status can effect the psychological status, but not the enabling resources. Eight dimensions of quality of life are related to the out-patient utilization of the Western medicine. The out-patient utilization of the Chinese medicine is related to the physical pain only. The quality of life of physical function, general health and social function are the main factors for the out-patient utilization of the Chinese and Western medicine. The physical pain is the main factor for the out-patient utilization of the Chinese medicine, but not the psychological status. Conclusion and suggestion In recent years, the convenient transportation, trans-regional employment and universal health care that make no difference on the use of Western and Chinese medicine out-patient medical services between Kaohsiung County and Kaohsiung cities. Over 65 years and female have more out-patient utilization and self-report health and chronic diseases are the most important factors for the Western medicine out-patient utilization. There are also associated with the health-related quality of life. We suggest strengthening the health education, preventing health measures for high-risk population and increasing health promotion activities of the community. To provide the psychological and physical resources for public , prevent early, use of medical resources effectively and promote the health quality of life. Because of the large hospitals have attached Chinese medicine sector, regional population structure, changes in disease patterns of growth and decline and medical institutions, the choice of medical treatment may also change for public, we suggest that the medical institutes should analyze the impact of the use of medical services regularly, in order to, provide more appropriate medical services and strengthen the operation and development for medical institutions.