骨關節炎患者中西醫門診醫療利用情形及其相關因素-以2004-2005年承保抽樣歸人檔為例

Abstract

Background and objectives: Osteoarthritis (OA) is the most common arthritis disease and there are various services nowadays. People can choose traditional Chinese medicine besides wstern medicine, which results in health services utilization of plural care phenomena. The purposes of this study were to explore health services utilization of western and traditional Chinese medicine by osteoarthritis patients under the National Health Insurance and its related factors. Method: The source of the data came from claims data of the first to fourth sets of sampled registry of beneficiaries of National Health Insurance of 2004 and 2005. ICD-9-CM with initial three codes as 715 were selected from the panel database. Cases were traced for one year after the first visit in the claims file. A total of 3,841 patients were identified and divided into three groups, namely western medicine care group, Chinese medicine care group, and Chinese and western medicine care group. There were 3,714 patients in western medicine care group, 67 in Chinese medicine care group, and 60 in Chinese and western medicine care group. Data were analyzed by using student’s t test and Analysis of Variance (ANOVA). Stepwise regression analysis was used to explore health services utilization of western and traditional Chinese medicine and its related factors. Result: The proportion of patients using western medicine ambulatory care and emergency, Chinese medicine ambulatory care, Chinese and Western medicine ambulatory care and emergency were 96.69%, 1.74%, and 1.56%, respectively. In terms of patient characteristics, patients tended to be female, aged 40-49, 50-59 and 60-69 years old, with comobidity or complications of Spondylosis and allied disorders and Other disorders of soft tissues, other and unspecified disorders of back. For western medicine ambulatory care and emergency, the majority of patients received care from private hospitals, clinics, Taipei Branch. In accordance with Chinese medicine ambulatory care, people received care from public, clinics, Taipei Branch were in the majority. In personal visit of Chinese and Western medicine care, people received care from non-profit proprietary hospitals, clinics, Taipei Branch were in the majority. In terms of health services utilization patterns, the average accumulative medical expenses, accumulative days of prescription, accumulative number of visit for western medicine ambulatory care, were 6,965.41 points per person, 6.33 times, 80.55 days； for Chinese medicine ambulatory 3,883.51 points per person, 4.93 times, 48.1 days； and for Chinese and Western medicine ambulatory care 8,132.72 points per person, 8.38 times, 95.13 days. Multiple regression results indicate that osteoarthritis personal visit, ambulatory and emergency care accumulative expenses per patient visit for Western medicine, days of prescription, accumulative visit times were significantly related to gender, age, comobidities and complication, whether or not have to pay copayment. The accumulative expenses of Chinese medicine visits, days of prescription were significantly related to comobidities and complication, and days of prescription. Accumulative visit times were related to visiting place; ambulatory and emergency care. Accumulative expenses per patient visit for Chinese and Western medicine was significantly related to sex, visiting place. Accumulative visit times and days of prescription were significantly related to ownership of provider. Patients medical treatment models of Western medicine care, Chinese medicine care and Chinese/Western medicine care were significantly related to the accumulative medical expenses and accumulative visit times. Conclusion: This study found that gender, age, copayment status, comobiditries/complication, ownership of provider, contracted category and visiting place of osteoarthritis patients were significantly related to the medical utilization of Western medicine care, Chinese medicine care and Chinese/Western medicine care.