title: Utilization pattern of traditional Chinese medicine for liver cancer patients in Taiwan.
abstract: BACKGROUND
  Traditional Chinese Medicine (TCM) is one of the most popular complementary and alternative medicine modalities worldwide. In Chinese and East Asian societies, TCM plays an active role in the modern health care system and is even covered by the National Health Insurance Program of Taiwan. Liver cancer is the second most common cancer in Taiwan. This study aimed to analyze the TCM utilization patterns of patients with liver cancer from 1996-2007 using a population-based random sample of one million insured patients.
  
  
  METHODS
  A cross-sectional study was conducted using registration and claim data sets from 1996 to 2007 obtained from the Longitudinal Health Insurance Database 2005 (LHID2005). The outpatient datasets contained the encounter form-based dates of visit, three items from the International Classification of Diseases (Ninth Revision, Clinical Modification codes), the primary procedure (e.g., drug or diagnostic procedure), type of copayment, billed amount, and paid amount. Only ambulatory care was analyzed.
  
  
  RESULTS
  A total of 6358 liver cancer patients utilized ambulatory care during the study period. Among them, 1240 (19.50%) availed of TCM outpatient services. The prevalence of TCM use fluctuated during the study period, with a peak of 25.11% in 2001. After multivariable adjustment, the likelihood of TCM users was lower in participants aged 70 years and older (odds ratio, OR = 0.79, 95% confidence interval, CI: 0.64-0.97), males (OR = 0.60, 95% CI: 0.52-0.68), residents of Taipei (OR = 0.75, 95% CI: 0.58-0.96) as well as farmers and fishermen (OR = 0.71, 95% CI: 0.54-0.94), but was higher in residents of central Taiwan (OR = 1.99, 95% CI: 1.56-2.54. Most biomedicine and TCM outpatient services were provided by private clinics, followed by private hospitals. The two most frequently recorded coexisting diseases for both biomedicine and TCM outpatient visits specifically for liver cancer were (1) chronic liver disease and cirrhosis, and (2) malignant neoplasm of the liver and hepatic bile duct. The mean fee per visit for biomedicine was much higher than that for TCM, and the average expenditure was NT$429.73 (US$13.25) per biomedicine visit and NT$301.93 (US$9.32) per TCM visit (US$1 = NT$32.4 in 2007). For outpatient visits specifically for liver cancer, the mean fee per visit for biomedicine was much higher than that for TCM. The average cost per visit was NT$1457.31 (US$44.98) for biomedicine and NT$1080.76 (US$33.36) for TCM.
  
  
  CONCLUSIONS
  TCM was widely used by the patients with liver cancer, and the prevalence of TCM use remained stably high during the study period. The costs of insurance covering TCM were consistently lower than those covering biomedicine in patients with liver cancer. The findings of this study should be useful for health policy makers as well as researchers considering the integration of TCM and biomedicine.
authors.affiliation: Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Yueh-Hsiang
authors.initials: YH
authors.lastname: Liao
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Lin
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
authors.forename: Jaung-Geng
authors.initials: JG
authors.lastname: Lin
mesh_terms: D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data; D001650:Bile Duct Neoplasms / Q000628:therapy; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005249:Fees and Charges; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006761:Hospitals; D006801:Humans; D007348:Insurance, Health; D008103:Liver Cirrhosis / Q000628:therapy; D008113:Liver Neoplasms / Q000191:economics / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008516:Medicine, Chinese Traditional / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D009790:Occupations; D017149:Private Sector; D012111:Residence Characteristics; D012737:Sex Factors; D013624:Taiwan