研究目的:瞭解下背痛病人在接受中醫與西醫治療之人口特性、就醫次數與醫療費用,並探討中西醫療費用間的替代性。 研究方法:分析樣本醫院2007年之健保申報資料,比較相同疾病的病人在不同的就醫行為模式下,其醫療利用情形有無不同並探討影響病患就醫行為的因素。 研究結果:在樣本醫院治療下背痛疾病之病患,男、女性別間對於就醫類別的選擇雖有不同,但無顯著差異。從醫療利用模式來看,不論是男性或女性在中西醫併用的使用次數均遠高於單純使用中醫或單純使用西醫的次數,故推論中西醫併用的模式在樣本醫院無替代效果,且門診利用率會隨著年齡增加而遞增(中、西醫皆同),在75歲以上達到最高。從醫療利用率來看,使用中西醫併用方式之病患的每人平均費用約較單純使用中醫或西醫高,且會因病患本身是否需負擔費用而有不同。下背痛疾病在不同醫療利用型態下之平均次數、年之門診累計費用、年使用次數、連續就醫年數有顯著性差異。 結論與建議:從每人平均就醫次數得知,下背痛在樣本醫院的中西醫併用模式,彼此間並未有替代效果且對於健保資源有過度使用的現象。但是國內相關臨床研究及實證都顯示中西醫療併用對些疾病有確實效果。經比較每人平均費用或每次平均費用,西醫均比中醫高。該情況應和西醫較常使用檢驗或檢查來輔助治療,而中醫較少使用檢查有關。建議將特定疾病各階段之管理進行醫療整合,有效率、有效果的使用醫療資源。
Purpose: To compare the demographic profiles, number of medical visits and medical expenditures in patients with low back pain receiving Chinese medical treatment or Western medical treatment, and to study the substitution effect between these two medical treatments. Methods: The data that the sample hospital submitted to the National Health Insurance (NHI) in 2007 were used to compare whether patients receiving different medical treatments exhibit differences in medical utilization and to investigate the factors influencing their medical care seeking behavior. Results: There is difference, but not statistically significant, in the choices of medical treatment types among male and female patients having low back pain in the sample hospital. With regard to the pattern of medical utilization, the number of patients receiving both types of medical treatments in male or female patients was significantly greater than receiving only either type of treatments. It could be inferred that the pattern of receiving both types of treatments was irreplaceable in the sample hospital, and the utilization rate of outpatient services would increase with age until it reaches a maximum in patients aged above 75. Conclusions and Suggestions: Patients with low back pain receiving both types of medical treatments in the sample hospital seemed to overuse the recourses of National Health Insurance. The average cost per person or per visit shows higher in the Western medical than Chinese traditional treatments, and it is explained by the fact that more tests in the Western medical treatment.