Factors associated with patient and hospital participation in the NHI Chinese Medicine Supplementary Rehabilitation Program for Cerebrovascular Patients in Taiwan

• Main Authors: Chen-Hua Feng, 馮震華
• Other Authors: Nicole Huang , Ph.D.
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/65916280557825699461

碩士 === 國立陽明大學 === 醫務管理研究所 === 103 === Background Since 2006, NHIA launched “Chinese Medicine Supplementary Rehabilitation Program for Cerebrovascular Patients in Taiwan" (hereinafter referred to as Chinese Medicine Supplementary program), cerebrovascular disease (hereinafter referred to as stroke) in patients hospitalized merges with treatment of scientific Chinese medicine and acupuncture in order to reduce the residual side effect and health care expenses. Literature studies show that after this project intervention, the function of patients neurological has been improved which is more economically cost-effective and is worthwhile. However, only 38% of hospitals participate in the plan and only 6% of inpatients merge with the treatment of Chinese medicine which is significantly lower. Objective The purpose of this research is to investigate the effect of Chinese medicine supplementary program on Chinese medicine outpatients in and not in this program and on stroke inpatients who participate this program. This research also adopts interviews to investigate the low percentage of this pilot program. It also helps the government to promote the health care policy.. Materials and methods The research is cross-sectional research which adopts qualitative and quantitative research methods for subsequent analysis. Quantitative Analysis joins the National health insurance research database of sampling from millions of people with health insurance and 10 data files of medical institutions, medical personnel, outpatient and inpatient expanse lists from 2006 to 2011. It selects 98 hospitals with Chinese medicine outpatient and 7,322 inpatients with ICD_9_CM 430-438 cerebral vascular disease. Qualitative research adopts interviews with department high-end executives in hospitals and six Chinese and Western physicians to explore the differences and factors of Chinese medicine supplementary program on patients. The database and analysis use SAS 9.3 software package with level of P <0.05. Results 一、The factors of Chinese medicine supplementary program in hospitals with Chinese medicine outpatient., The participating hospitals which factors associated with located in Central Taiwan, private ownership, medical center base, hospital beds more than 1200, over 6 Chinese medicine doctors and average over 1200 hospitalized stroke patients had the highest rate of participation. Futher, the factors with hospital ownership, contract type with NHI, numbers of Chinese doctors, and average hospitalized stroke patients numbers reached statistical significant level. The results were consistent with findings by the focus group. 二、The factors effected hospitalized patients to take the program: The patients are the age of 31-64, with health insurance and fixed salary in the companies, with longer inpatient days, and ever staying in intensive care units with rehabilitation treatments. These patients’ physicians specialize in rehabilitation. The hospitals are private and have larger scale of Chinese medicine department in mid and east Taiwan. Under the above conditions, the patients have higher percentage to participate in Chinese medicine supplementary service. This result matches the result of qualitative method. Conclusions 一、The factors including public/private hospital ownership, contract of medical center with NHI, metropolitan/local hospital, numbers of Chinese medicine doctors, average hospitalized stroke patients were relevant with “the Chinese Medicine Supplementary Rehabilitation Program of Cerebrovascular Diseases” and reached the statistical significant level. Those factors were also significantly associated with taking the program. 二、Those patients whose physicians specialize in rehabilitation have higher percentage to participate in Chinese medicine supplementary service; instead patients with surgeon have lower percentage. The medical model of merging Chinese and Western medicine depends on physicians’ acceptance of Chinese medicine. Different areas of Chinese and Western physicians’ expertise influence their medical decision-making., 三、Patients who were between 31-64 years old,patients with or without health care, and patients’ severity of stroke (including longer inpatient days, patients ever in intensive care unit, and patients with rehabilitation therapy) have significant influence on their acceptance of Chinese medicine supplementary service.