title: Utilization patterns of Chinese medicine and Western medicine under the National Health Insurance Program in Taiwan, a population-based study from 1997 to 2003.
abstract: BACKGROUND
  In 1995, Taiwan has launched a national health-care system (the National Health Insurance Program, NHI) covering the use of both Western medicine (WM) and Chinese medicine (CM). This population-based study was conducted to understand the role of CM in this dual medical system by determining the utilization patterns of CM and WM and to analyze the demographic characteristics and primary indications influencing the choice of the medical services for the development of strategies to enhance the appropriate use and reduce unnecessary use of CM.
  
  
  METHODS
  This study used the NHI sample files from 1997 to 2003 consisting of comprehensive utilization and enrolment information for a random sample of 200,432 NHI beneficiaries of the total enrolees from 1995 to 2000. A total of 136,720 subjects with valid and complete enrolment and utilization data were included in this study. The logistic regression method was employed to estimate the odds ratios (ORs) for utilization of CM and WM. The usage, frequency of services, and primary indications for CM and WM were evaluated. A significance level of alpha = 0.05 was selected.
  
  
  RESULTS
  Compared with WM, the odds of CM increased from 1997 to 2003. The odds of using CM (OR = 1.48; 95% CI: 1.45-1.50; p < 0.001) and WM (OR = 1.74; 95% CI: 1.72-1.77; p < 0.001) were higher in females and that of CM increased with age to a peak in the 45-54-year-group (OR = 1.75; 95% CI: 1.68-1.82; p < 0.001) and WM (OR = 1.09; 95% CI: 1.05-1.13; p < 0.001) in the elderly subjects (> or = 65 years). The odds of CM and WM were similar in all income groups. However, those of CM were higher in Central (OR = 1.65; 95% CI: 1.56-1.74; p < 0.001) and Southern Taiwan (OR = 1.18; 95% CI: 1.12-1.25; p < 0.001) and lower in the remote areas (OR = 0.57; 95% CI: 0.52-0.63; p < 0.001). Most of the patients had one ambulatory visit of both medical services annually. However, the utilization of WM predominated over CM. Over 90% of CM service was provided by clinics, whereas over 60% of WM service by hospitals. Diseases of the respiratory system was the most frequent primary indication in CM and WM. Herbal medication was the most commonly used form of CM (68.4-72.7%).
  
  
  CONCLUSIONS
  In recent years, there is an increasing trend in the utilization of CM in Taiwan. This increasing trend may be due to the covering of CM in the national health insurance system.
authors.affiliation: Institute of Traditional Medicine & Institute of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan.Lchin@ccmp.gov.tw
authors.forename: Lee-Chin
authors.initials: LC
authors.lastname: Chang
authors.forename: Nicole
authors.initials: N
authors.lastname: Huang
authors.forename: Yiing-Jenq
authors.initials: YJ
authors.lastname: Chou
authors.forename: Chen-Hua
authors.initials: CH
authors.lastname: Lee
authors.forename: Feng-Yu
authors.initials: FY
authors.lastname: Kao
authors.forename: Yi-Tsau
authors.initials: YT
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008516:Medicine, Chinese Traditional / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs; D012720:Severity of Illness Index; D012923:Social Class; D013624:Taiwan; D019366:Western World