臺灣中老年人複向求醫之影響因素探討

Factors related with pluralistic medical utilization among the middle aged and elderly in Taiwan

楊爵憶(Yang Jue Yi)

指導教授 ： 徐慧娟

亞洲大學/健康學院/健康管理研究所/碩士(2003年)

摘要

本研究針對西醫門診、中醫門診與藥局的醫療服務利用，探討臺灣中老年人多元求醫行為。研究目的有三：（1）瞭解不同人口特徵的中老年人在醫療服務使用上的情形。（2）分析影響中老年人的複向求醫行為與複向求醫類型相關因素。（3）探討各醫療服務間的替代或互補關係。資料來源為臺灣家庭計畫研究所1996年臺灣地區老人保健與生活問題調查，研究樣本共計4799位50歲以上的中老年人，研究結果可作為衛生主管機構建構老人長期照護體系之參考。本研究重要發現如下：
1. 4799位樣本中，有71.2%曾使用過醫療服務；其中又有35.0%的人有複向求醫行為，西醫中醫併用佔28.14%，西醫藥局併用佔48.49%，西醫中醫藥局三者同時使用者佔16.9%。
2. 女性、50-64歲的中年人、居住於都市城市、對健保感到不滿、自覺健康較差、有重度憂鬱、有二種以上慢性病、患骨骼肌肉系統疾病、消化系統疾病、呼吸系統疾病、泌尿系統疾病者，愈偏好複向使用醫療服務。
3.女性、50-64歲的中年人、對健保感到不滿、自覺健康較差、有重度憂鬱、罹患消化系統疾病、呼吸系統疾病者，西醫中醫服務併用的比例較高。
4.男性、50-64歲的中年人、自覺健康較差、有重度憂鬱、有二種以上慢性病、患骨骼肌肉系統疾病、消化系統疾病、呼吸系統疾病者，西醫藥局服務併用的比例較高。
5.50-64歲的中年人、自覺健康較差、有重度憂鬱、罹患消化系統疾病者，較傾向西醫中醫藥局三者服務併用。
6.不論合併使用幾種服務，在中老年人的複向求醫行為模式中，西醫中醫、西醫藥局、中醫藥局皆呈現替代關係。
依據研究結果，對於老人保健與生活問題調查計畫，建議問卷內容加入健康照護體系與消費者滿意度等相關問題。未來研究可採用自擬問卷或質性研究，以彌補二手資料變項不足的缺憾。對衛生主管機關之建議：1. 正確健康知能與求醫行為的宣導，2. 家庭醫師制度的建立與推廣，3. 設置中西醫合併照護門診，4. 重視心理健康照護需求。

關鍵字

老人 ； 醫療服務利用 ； 複向求診 ； 替代關係 ； 互補關係

並列摘要

This study explores behavior of pluralistic medical utilization among the middle aged and elderly ( aged 50 years and over) in Taiwan. Three kinds of medical services utilization are specified: 1.western medicine , 2.traditional Chinese medicine, 3.pharmacy. The purposes of this study were:1. to understand the behavior of health services utilization among the middle aged and elderly in Taiwan; 2. to explore the choice of health services between dual method treatment; 3. to discover the substitution or complementary effect between health services. Data came from the 1996 Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan, involving 4799 respondents after weighting.
Major findings are as follow:
1. There were 71.2% of the interviewed utilized medical services one month before the survey. 35.0% utilized pluralistic treatment. Among them, 28.14 utilized western medicine and traditional Chinese medical care, 48.49% utilized western medicine and pharmacy, 16.9% utilized triple method treatment.
2. By logistic regression analysis, the significant variables related to the proneness to the pluralistic treatment were the female, the middle aged, living in city, having dissatisfied with NHI, having bed health status, serious melancholia, having more than two kinds of chronic
diseases , suffering disorders of the respiratory, digestive, genitourinary and musculoskeletal system.
3. By logistic regression analysis, the significant variables related to the proneness to the western medicine and traditional Chinese medicine were the female, the middle aged, having dissatisfied with NHI, having bed health status, serious melancholia, suffering disorders of the respiratory and digestive system.
4. By logistic regression analysis, the significant variables related to the proneness to the western medicine and pharmacy were the male, the middle aged, having bed health status, serious melancholia, having more than two kinds of chronic diseases , suffering disorders of the respiratory and musculoskeletal digestive system..
5. By logistic regression analysis, the significant variables related to the proneness to the triple method treatment were the middle aged, having bed health status, serious melancholia and suffering disorders of the digestive system.
6. In those who chose two or three kinds of health services, they considered the western medicine as a substitution to the traditional Chinese medical care and pharmacy.
Recommendations to the government and for future studies are also included.

並列關鍵字

elderly ； medical service utilization ； pluralistic medical utilization ； substitution effect ； complementary effect

參考文獻

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