本研究目的在於探討全民健保制度之下,影響民眾選擇中醫或西醫的因素,以及選擇中醫或西醫所需的醫療成本花費是否有差異、治療的成效是否不同。由於並不是所有的疾病都是可以選擇西醫或是中醫進行診療,因此本研究選取脫臼扭傷此一常見之疾病進行實證分析。實證資料來自民國90年健保資料庫之「門診處方及治療明細檔」,以及民國90年國家衛生研究院之「國民健康訪問調查」問卷資料。本研究利用Logit模型,探討影響脫臼拉扭傷病患就醫選擇(西醫或中醫)的因素;接著以OLS迴歸分析不同特性以及就醫選擇對於治療天數、醫療費用的影響;最後,再使用logit模型,估計不同特性和就醫選擇對於再回診機率之影響。 研究結果發現在影響中西醫的就醫選擇因素上,女性、年紀愈輕者、一般地區、北部地區、佛道信仰、學歷較高、所得介於2萬到4萬之間、客家族群等變數,選擇中醫的機率比較高。在治療天數方面,中醫的治療天數明顯高於西醫,年紀愈大者,其治療天數會愈長。而治療費用的實證結果顯示,中醫的治療費用明顯高於西醫;偏遠地區(山地和離島)、城鎮、北部地區其醫療費用是比較高的。最後,中醫或西醫的就醫選擇並不會影響再回診的狀況,年紀愈大、鄉村、目前無工作,其再回診的機率比較高。雖然中醫的治療天數和費用可能比西醫來得高,然而其再回診率和西醫並沒有明顯差異,因此無法下定論究竟中醫或西醫療法哪個比較具有成本效益。所以醫療政策的制定與衡量,應同時考量中西醫的均衡發展、並且引導醫療資源適當使用,朝中西醫整合方向邁進,如此才是全民的福祉。
The purpose of the study is to examine an individual’s medical care choices between Chinese medicine and Western medicine under the National Health Insurance System in Taiwan. In addition, the differences of the cost and outcome between Chinese medicine and Western medicine are also discussed. Since not all diseases can be treated by Chinese medicine or Western medicine, this study chooses dislocation and sprain which can be commonly cured by Chinese medicine and Western medicine. The data used in this study is selected from a nationwide questionnaire survey and the NHI data base in 2001. Individuals who are over 18-yaer-old and went to hospital due to dislocation or sprain illness are included. The study uses Logit model to examine the factors that determine an individual’s choice of medical care, and then uses OLS model to analyze the costs of the care. Finally, Logit model is used to analyze the probability of revisit between Chinese medicine and Western medicine. The results show that females, young adults, individuals who live in the northern Taiwan, individuals whose religion are Buddhism or Taoism, individuals with higher education level, the Hakka, are more likely to choose Chinese medicine. In addition, treatment days and cost of Chinese medicine are longer and higher than Western medicine. Finally, the study shows that different medical care treatment would not affect the probability of revisit. Even though the cost of Chinese medicine is higher than Western medicine, the probability of revisit is not significantly different between the two cares. Therefore, we can not conclude that Chinese medicine or Western medicine is more cost-effective than the other. Health policy makers should consider a balanced development between Chinese medicine and Western medicine. It may lead to use the medical resource more appropriately and to integrate Chinese medicine and Western medicine to induce more benefit for the people in Taiwan.