全民健康保險中醫門診利用暨影響因素之研究

An Analysis of the Utilization of Chinese Medicine and Relative Factors under National Health Insurance in Taiwan

本研究以Aday and Andersen 之醫療服務利用模式為研究無構，利用1997 年中央健康保險局保險對象承保檔及全民健康保險學術研究資料庫之中醫 「門診處方及治療明細檔」，獲得有效研究樣本210 多216 筆，進行保險對象中醫 門診利用分析，並以複迴歸統計方法探討其影響因素。 研究結果顯示1997 年利用中醫門診比率為25.7% '平均每人中醫門診利 用次數為1. 29 次，平均每人中醫門診醫療費用為585 元。在疾病別中，以「脫 臼'扭傷及拉傷」之利用次數及費用最高。在影響因素方面，不同性別、年 齡、投保類別、投保金額、投保身份、是否部分負擔、是否為慢性病、是否 為重大傷病、投保地區每萬人口中醫師數及西醫師數之保險對象其中醫門診 利用不同。 本研究結果發現，我國中醫疾病分類品質欠佳，中醫疾病分類系統急需 早日建立。建議健保局應深入評估中醫門診利用之影響因素以調整中醫門診 總額預算之分配並且亦應主動評估中醫納入長期照護及特定疾病照護之效 用。對中醫醫療管理而言，目前我國中醫門診利用與持續性皆偏低，醫療機 構管理者應設法吸引其有高度利用中醫門診特質的顧客前來就診，並積極拓 展中醫醫療市場，此外，也應找出影響民眾持續利用中醫門診的因素，將顧 客轉變成重購顧客，強化顧客關條管理。

This study analyzed Chinese medicine utilization under National Health Insurance in Taiwan by applying Aday and Andersen s behavior model of health service utilization. Through stratified random sampling of 1% of the National Health Insurance enrollee data file, we collected 210,216 enrollees Chinese medicine utilization claims data file for 1997. Using multiple regression method to analyze factors associated with the utilization of Chinese medicine. This research showed that 25.7% of the sample population utilized Chinese medicine in 1997 and the annual average number of outpatient visits was 1.29, and annual average expenditure was 585 New Taiwan dollars. Through regression analysis, we found gender, age, insured payroll-related amount, insured by beneficiary category, with or without copayment, with or without chronic disease, with or without major injury or disease, local number of physicians as well as Chinese medicine doctors per 10,000 population factors are significantly related to the utilization of Chinese medicine. This study suggested government agencies should develop a better diagnosis coding of Chinese medicine. The findings of this study can also be helpful in adjusting the mechanism of global budget as well as the evaluation of Chinese medicine for long-term care. For hospitals and clinics of Chinese medicine, this study can help to identify heavy users and market segmentation management should apply marketing techniques to identify first-time customers and transform them to repeatcustomers as well as enhancement of customer relationship management.