Utilization of ambulatory Chinese medical services under the National Health Insurance in Taiwan

Objective: The objectives of this study were: first to describe the utilization of ambulatory Chinese medical services of the NHI enrollees and how it varied according to the insured's age, sex and geographical location; second to discuss the influences of the characteristics of the patients, attributes of the diseases, and local medical resources on the Chinese medical services utilization, Method: This study applied secondary data analysis to representative NHI enrollees sample files in the year 2000 provided by the National Health Research Institute. And with the assistance of the Bureau of National Health Insurance, the sample files were linked with the Family Registration File. A total of 88,101 enrollees alive in 2000 were retrieved as the study subjects. This study used two-part model regression analysis to analyze the factors affecting the utilization of ambulatory Chinese medical services. Result: 1) On average, the utilization rate of ambulatory Chinese medical services was 1.264 visits per person per year in 2000. Female had a higher utilization rate than male (1.477 visits vs. 1.051 visits). However, age-specific utilization rate presented a "reverse U" curve, with a peak occurred among 35 to 65 years of age, in contrast to the "J" curve of the utilization of ambulatory western medical services. 2) The age- and sex- adjusted utilization rates by the six BNHI branches were (from high to low): 1.922 visits for the Central Branch, 1.302 visits for the Southern Branch, 1.246 visits for the Kao-Ping Branch, 1.016 visits of the Northern Branch, 0.990 visits for the Taipei Branch, and 0.877 visits for the Eastern Branch. 3) The age- and sex- adjusted utilization rates differed significantly among 17 medical care regions. The five regions with the highest rates were: 2.134 visits for the Taichung medical region, 1.665 visits for the Changhua medical region, 1.483 visits for the Nantou medical region, 1.347 visits for the Tainan medical region, and 1.309 visits for the Yunlin medical region. Three regions with the lowest rates were: 0,679 visits for the Taitung medical region, 0.923 visits for the I-Lan medical region, and 0.954 visits of the Taoyuan medical region. 4)Two-part regression model showed that people retaining the following characteristics were more likely to have higher utilization rates of ambulatory Chinese medical services: female, people aged between 40 to 70, non-aboriginal, sub-urban citizens, patients with chronic disease, and living at areas with more sufficient manpower resources in Chinese medicine but less sufficient manpower in western medicine. Conclusion: The results show that Chinese medical services utilization rates varies significantly among different geographical regions. Besides, patient characteristics, the attributes of diseases and the adequacy of Chinese medical resources, all have an important impact on the Chinese medical utilization rates.