探討台灣地區中西醫門診複向求醫行為及影響因素

The Pluralistic Medical Service Utilization of Outpatient Traditional Chinese and Western Medicine and its Relevant Influencing Factors in Taiwan.

黃威翔(Wei-Siang Huang)

指導教授 ： 黃偉堯

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2016年)

摘要

背景
在台灣地區，民眾在面對疾病時，使用西醫的同時也會使用中醫療法，形成「複向求醫行為」。1995年全民健保開辦，提高就醫可近性，民眾發生疾病時可以自由選擇西醫、中醫或中西醫複向求醫。
目的
探討複向求醫行為的利用型態與影響因素。
方法
資料來源為國衛院健保資料庫中2010年承保抽樣歸人檔，分析對象為2008年單一疾病在單一縣市就醫之民眾。依變項為複向求醫行為，自變項為性別、年齡、投保金額、部分負擔、每萬人口醫師數與疾病分類。以卡方檢定(Chi-square Test)分析自變項與依變項的相關性；並以羅吉斯迴歸(Logistic regression) 分析自變項與複向求醫行為的關係。
結果
單一疾病於相同縣市使用醫療服務的研究對象計有121,494人，發生複向求醫的比率為2.6%。其中在複向求醫民眾的特質上，男性發生複向求醫的比率為2.5%、女性為2.8%；年齡上，最多的為小於等於19歲組，佔3.0%，最少的為65歲以上民眾，佔1.3%；部分負擔變項中，部分負擔者的發生複向求醫的比率為2.7%，免部分負擔者發生的比率則為1.0%；在投保金額裡，以月投保金額2,801~87,600元以下的民眾最多，佔3.1%，最少的為月投保金額126,301元以上的民眾佔1.5%；依每萬人口醫師數為分析基準，發生最多複向求醫的是每萬人口醫師數22.60人的臺中市(每萬人口醫師數排名第三)，佔4.0%；最少的為每萬人口醫師數11.28人的連江縣(每萬人口醫師數排名第二十)與每萬人口醫師數5.91人的金門縣(每萬人口醫師數排名第二十二)，在本次研究條件的設定下，未篩入有複向求醫行為的民眾；疾病分類別裡，以損傷及中毒者最多，佔6.2%，精神疾患與傳染病及寄生蟲病最少，皆佔0.1%，所有補充分類、周產期病態、先天畸形、妊娠生產及產褥期之併發症與血液及造血器官之疾病在研究條件篩選下則未有發生複向求醫的情況發生。
以羅吉斯迴歸(Logistic regression)分析，自變項中以各影響因素的分組來看，最容易出現複向求醫者分別為女性、小於等於19歲的民眾、需部分負擔者、月投保金額72,801~87,600元與疾病分類別為損傷及中毒者；每萬人口醫師數則與複向求醫未達統計相關(p＞0.05)。
結論
單一疾病分類別在單一縣市就醫者，複向求醫的比率2.6%。其中在民眾產生複向求醫行為的個人因素上，性別、年齡、部分負擔、月投保金額與疾病類別皆會影響門診複向求醫行為。
關鍵字：複向求醫、門診醫療利用、求醫行為、中醫、西醫

關鍵字

複向求醫 ； 門診醫療利用 ； 求醫行為 ； 中醫 ； 西醫

並列摘要

Background
The Taiwanese patients often utilize Western medicine and Traditional Chinese medicine concurrently, resulting in the action of “medical pluralism”. Since the establishment of National Health Insurance in 1995, medical accessibility has dramatically increased, allowing patients to seek treatment from either Western or Traditional Chinese medical doctors, yet it has also led to pluralistic medical utilization.
Objective
This study aims to investigate the pattern and factors of pluralistic medical utilization.
Method
This study utilized the Longitudinal Health Insurance Database of 2010 in the National Health Insurance Database from the National Health Research Institutes. Subjects are patients who have at least one medical record due to single disease in the same city or county in 2008. Research variables include pluralistic medical utilization behavior as dependent variable, and gender, age, payroll tax amount, copayment, number of doctors out of 10,000 persons and disease category (based on ICD-9-CM) as independent variables. Chi-square test was used to determine the correlation between the independent and dependent variables. Logistic regression was used to determine the association between independent variables and behaviors of medical pluralism.
Results
A total of 121,494 patients with a single disease who received medical treatments in the same city/county are investigated in this study, the occurrence of pluralistic medical utilization was 2.6%. Regarding the characteristics of people who have pluralistic medical utilization behaviors, the occurrence of pluralistic medical utilization was 2.5% in male patients and 2.8% in female patients. Regarding the age, the occurrence was highest in ≤19 year-old group (3%) and lowest in ≥65 year-old group (1.3%). As for the copayment variable, the occurrence was 2.7% in patients who were required to make copayments, and 1.0% in patients who were not. Regarding the insured amount, it was highest (3.1%) in patients who paid a monthly insured amount under $72,801~87,600, and lowest (1.5%) in patients who paid a monthly insured amount over $126,301. When the number of doctors per 10,000 people was used as a basis for analysis, it is shown that the occurrence of pluralistic medical utilization was highest in Taichung City (4.0%), where the number of doctors per 10,000 people was 22.60 (third largest in number of doctors per 10,000 people); the occurrence was lowest in Lianjiang County, where the number of doctors per 10,000 people was 11.28 (twentieth largest in number of doctors per 10,000 people) and Kinmen County, where the number of doctors per 10,000 people was 5.91 ( twenty-second largest in number of doctors per 10,000 people). No sample of Lianjiang County and Kinmen County patients was taken into this study. With respect to the category of the disease, the occurrence was highest (6.2%) in patients in the supplementary classification of external causes of injury and poisoning category, and lowest (0.1%) in patients with mental disorders, infectious and parasitic diseases. No occurrence was found in all other supplementary classification, perinatal period morbidity, congenital anomalies, pregnancy, complications during pregnancy and puerperium, and diseases of the blood and hematopoietic organs.
To evaluate the influencing factors in the independent variables, logistic regression analysis was used and showed that patients being female, 19 or younger, with an actual monthly salary below 72,801~87,600, and within the supplementary classification of external causes of injury and poisoning category are more likely to have behaviors of medical pluralism, while the number of doctors per 10,000 people is not statistically correlated to pluralistic medical utilization (p＞0.05).
Conclusion
This study found that the incidence of medical pluralism is 2.6% in patients who received medical treatments in a single city/county for a single disease. Among people's individual factors of pluralistic medical utilization behavior , gender, age, patient who have copayment,monthly insured amounts, and disease type can all have an effect on the behavior of pluralistic medical utilization.
Keywords：
pluralistic medical utilization., outpatient utilization, health seeking behavior, Traditional Chinese medicine, Western medicine.

並列關鍵字

pluralistic medical utilization ； outpatient utilization ； health seeking behavior ； Traditional Chinese medicine ； Western medicine

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