| Summary: | 碩士 === 中國醫藥大學 === 醫務管理研究所 === 92 === Objectives. This research focus on the health care utilization variations among elderly persons (age greater than 65) between “Chinese and western medicine” care pattern group and “western medicine” care pattern group. This study also explored whether elderly persons had significant doctor shopping behavior.
Methods. This study has used the National Health Insurance Research Database of 100,000 Beneficiaries Claims Data Files in 2002, and selected outpatient visit data of people aged 65 and over. The data set include 8,429 elderly people, and have been divided into several medical care utilization pattern groups, as follows: “Chinese and western medicine care group,”“western medicine care group,” “plural care group,” “ non-plural care group,” “ doctor shopping group,” “non-doctor shopping group,”. The descriptive statistic, t-test, χ2-test, and Logistic regression analysis are conducted to analysis the data.
Results. 1. There are 2,047(24.9%) people in the Chinese and western medicine group, among this group 1,327 people are plural care users, and 685 people of these users have significant doctor shopping behavior. The other 6,382(75.7%) people are in the western medicine care group, among this group 3,559 people are plural care users, and 1,620 people of these users have significant doctor shopping behavior. 2. The most common diseases of these people are “Acute Upper Respiratory Infection,” “Hypertension,” and “Diabetes Mellitus.” 3. Patients whose characteristics are older, with chronic diseases, with higher emergency visits, with higher number of different outpatient doctors, with higher inpatient visits, or at higher physician density regions have low probability to use both Chinese and western outpatient services. Patients with higher number of different outpatient specialties or clinics visits, or at higher Chinese physician density regions have high probability of combined use of Chinese and western outpatient services. 4. Persons with co-payment, or with high different outpatient clinics visits have low inclination of plural medical care. However persons with chronic diseases or higher emergency visits, or higher outpatient visits, or higher number of different outpatient doctors, the higher probability of plural medical care. 5. Patients with chronic diseases, catastrophic illness, higher emergency visits, higher inpatient or outpatient services, or with higher number of different outpatient doctors have high probability of doctor shopping behavior. On the Contrarily, patients with higher number of different outpatient specialties or clinics have low probability of doctor shopping behavior.
Conclusions. Senior citizens with chronic disease, with higher outpatient, emergency and inpatients visits, or with higher outpatient doctors contact seems to show higher probability of doctor shopping behavior. Physicians should take more care of medical care needs of elderly people, and manage patient relationship well to avoid the plural care pattern or the doctor shopping behavior which arise from patients’ dissatisfaction of outpatient service.
|
|---|
