中醫資源可近性對於中醫門診利用之影響

The association between the resource accessibility and the utilization of Traditional Chinese Medicine

目標：探討中醫資源可近性不同變化情形，對於民眾中醫門診利用之影響，並分析中醫資源可近性與不同利用習慣者的關係。方法：本研究以中醫巡迴醫療施行區域與各年度的每萬人口中醫師數作為可近性之測量指標，共分為兩個子研究樣本：「可近性增加組」與「可近性降低組」，並依照可近性變化情形再區分個案組（中醫資源可近性有改變）與對照組。利用傾向分數配對（Propensity Score Matching）篩選對照組，以廣義估計方程式（GEE）進行差異中的差異法，搭配使用二部模型（Two-part model）進行分析；本研究採用健保資料庫進行分析，研究期間為2011年至2013年。結果：可近性增加組的個案其中醫門診利用皆顯著增加，中醫利用率的勝算比（odds ratio, OR）為1.094，個案組的中醫利用次數與費用改變率分別較對照組增加0.022%與0.128%；但對於可近性降低組的個案而言，其中醫門診利用皆顯著減少。結論：中醫資源對於中醫門診利用會造成影響，故建議主關機關能持續保障醫療資源缺乏地區民眾的之中醫就醫權益，並且須擬定相關政策以改善當前不同地區中醫利用差異之問題，以落實全民健保精神。

Objectives: Our objective in this study was to characterize the means by which changes in the availability of TCM affect the ambulatory utilization of TCM among various groups of TCM users. Methods: TCM mobile health care coverage and the number of TCM physicians per 10,000 were used to define accessibility. We focused on two groups of patients, as follows: individuals who faced an increase in access to TCM and individuals who faced a decrease in access to TCM. We also considered individuals who did not face any changes in access to TCM as a control group. Propensity score matching was used in the selection of the control group. After parameter matching, difference-in-difference analysis was used in conjunction with the generalized estimating equation (GEE) within a two-part model for analysis. Results: Individuals who were provided greater access to TCM increased their utilization of TCM, compared to the control group, as follows: probability (+1.094 x), frequency (+1.022 x), and cost (1.128 x). Individuals who experienced a reduction in access to TCM decreased their utilization of TCM, compared to the control group, as follows: probability (-0.823 x), frequency (-0.940 x), and cost (-0.763 x). Conclusions: Our results reveal that access to TCM resources affects the ambulatory utilization of TCM. We therefore recommend that efforts be made to improve access to TCM in areas where TCM resources are scarce and that the government develops policies aimed at narrowing the differences in the utilization of TCM.