Results of the present study revealed that the tendency of TCM utilization increased as the follow-up time increased, whereas the tendency of WM utilization decreased gradually as follow-up time increased. Women’s age, economic status, infertility, baby delivery, Ob/Gyn inpatient history and value of prevention were significantly associated with their medical care-seeking behavior.
We found that TCM utilization was only 0.69 and WM utilization was 1.75 within six months after the first menstrual syndrome diagnosis. Unlike some other disease symptoms, symptoms of menstrual discomfort occur frequently and periodically. For women who suffer menstrual discomfort every month, the frequency of related medical utilization is very low. Previous study revealed that most women suffer from menstrual discomfort but only a few will seek medical care [13, 14]. Participants in another study indicated that patient viewed seeking professional treatment was needed only if they felt the pain was too intense and unbearable [15]. It is reasonable to conclude that patients start looking for medical services when symptoms are more severe or unbearable [16].
TCM is widely used in Taiwan and other Asian countries. As part of Complementary and Alternative Medicine, TCM, like western medicine, is a scientific system with complete theory [17]. For better treatment results, the concept of TCM suggests the importance of constitutional adjustments, which will take a long time. Once patients accept the concept of TCM treatment, they will continue to return to the clinic for treatment, and the number of times is often more than at the initial starting point. TCM is usually used frequently by patients who would like to decrease recurrent symptoms and relieve the uncomfortable side effects of treatment [18]. On the contrary, the WM approach put more emphasis on immediate effect that may relieve symptoms quickly. However, menstrual syndromes may recur repeatedly, and patients’ expectations may be frustrated, so the number of clinical visits tended to decrease compared with the initial starting point. The author believes that this is the reason why the trend of TCM and WM utilization show an inverted pattern.
In terms of personal characteristics, women of younger ages (15–39 years old), those who have higher economic status, tend to use TCM clinics. The findings of this study are not consistent with those of previous studies. One previous study suggested that medical care-seeking is not associated with age [19]. In addition, older people are more likely to use TCM as their main form of care. However, with the recognition of Chinese medicine by WHO, younger people began to pay attention to the benefits of TCM for improving overall health status and conditioning the body, and they are more likely to actively seek ways to improve their well-being by curing the root of the problem. Therefore, more and more young people choose TCM as their main form of care. Another possible explanation is that older women already have more experience dealing with the menstrual syndromes. Instead of using TCM, they might use other alternative therapy or food remedies to solve these discomforts.
According to TCM, many ways of treatment are available to deal with symptoms, including medications, acupuncture, infrared rays, and so on. Although the NHI program covers TCM and makes these services affordable to all enrollees, many items are still not reimbursable by NHI. As a result, out-of-pocket items of complementary healthcare have become obstacles for low-income patients. The present study revealed that higher economic status was associated with TCM use, which is consistent with the findings of previous research [20].
Longitudinal data (60-months) from the present study revealed that women with medical history of infertility or who were ever hospitalized due to obstetrical/gynecologic disorders would likely use more clinical outpatient services of both TCM and WM. Because both TCM and WM clinical outpatient services are covered by NHI, we reasonably suggested that these women increased outpatient follow-up once they had been diagnosed with the documented medical history. Previous study also indicated that the extension of NHI benefits coverage led to an increase in the utilization of outpatient services across all income groups among patients [21].
On the other hand, the utilization of health preventive services, such as screening tests, had different effects on the use of TCM and WM outpatient services. Women receiving screening tests such as cervical Pap smears and mammography, were less likely to use TCM outpatient services, and were more likely to use WM outpatient services. Previous studies found that patients who underwent gynecological cancer screening were more likely to experience symptom discomfort and would therefore visit outpatient clinics for treatment [13]. In addition, the use of preventive healthcare is a category of WM. Therefore, women who performed these health prevention practices are basically more likely to agree with and therefore seek WM healthcare services.
The present study also found that women who have baby delivery history were tend to reduce the use of outpatient services. After the birth, the uterus and cervix are enlarged, the uterus no longer contracts excessively. When menstruation comes, the menstrual blood is discharged smoothly, and the discomfort of menstrual syndromes may be relieved.
Strengths and limitations
There are both strengths and limitations to the current study. An important strength of the study is that it used data from a comprehensive, national and high-quality database, which minimized discrepancies and biased studies. In addition, the use of longitudinal data allowed us to conduct long-term research and make it possible to explore the changes in long-term trends. Nevertheless, the present study has several limitations. Although the NHIRD is a large and trusted source of patient data, all analyses are retrospective, which does not rule out selection bias nor allow inference of cause. Also, certain patient data were not known, such as the use of Chinese herbal remedies obtained directly from TCM pharmacies with or without prescriptions from licensed TCM physicians. The study also did not include medical visits that were not covered by the NHI program. Thus, the frequency of outpatient utilization may have been underestimated. In addition, patients may have used both TCM and WM, or used WM first and then changed to TCM, and these patterns could not be differentiated.