Utilization patterns of Chinese medicine and Western medicine under the National Health Insurance Program in Taiwan, a population-based study from 1997 to 2003

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 (>= 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%). Conclusion: 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.