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JKM > Volume 35(3); 2014 > Article
Choi, Son, and Lim: The Relationship between the Use of Korean and Western Medicine in treating Musculoskeletal Disease

Abstract

Objectives:

The aim of this study was to identify the complementary and substitute relationships between the use of Korean medicine (KM) and that of Western medicine (WM) in the treatment of musculoskeletal disease.

Methods:

We analyzed the 2009 Korea Health Panel dataset. General characteristics and the medical utilization of respondents were analyzed descriptively. Logistic regression, negative binominal regression, and Tobit regression analysis were used to identify the relationships between the use of KM and the use, visit frequency, and expenses of WM, respectively.

Results:

In the treatment of musculoskeletal disease, KM use and non-herbal treatments with Korean medicine significantly reduced WM use. Herb medication use significantly increased WM visit frequency. There were no significant relationships between KM use and WM expenses.

Conclusions:

There are substitute relationships between WM use and KM use, especially non-herbal treatments in KM. Therefore we need to develop the clinical protocols of KM and WM treatments in the treatment of musculoskeletal disease for proper distribution medical resources.

Table 1.
The General Characteristics of Respondents
Variable Korean Medicine Servicea Western Medicine Serviceb N %


% χ2 % χ2


use non-use use non-use
Predisposing Factors
  Sex Male 11.14 24.38 20.54*** 34.53 0.99 7.54** 1,646 35.52
Female 24.51 39.97 63.45 1.03 2,994 64.48
  Age (years) Under 45 9.30 16.61 33.90*** 25.03 0.88 21.88*** 1,203 25.91
45–54 7.95 10.38 17.85 0.47 851 18.33
55–65 7.62 13.38 21.34 0.26 1,003 21.60
Over 65 10.77 23.39 33.75 0.41 1,586 34.16
  Education Under the middle school 18.01 38.10 32.65*** 55.24 0.86 7.15** 2,605 56.11
Graduate over the high school 17.64 26.25 42.73 1.16 2,038 43.89

Enabling Factors
  Residential Area outside 19.90 39.03 10.18*** 57.72 1.21 0.01 2,736 58.93
metropolitan area
metropolitan city 15.74 25.33 40.25 0.82 1,907 41.07
Household Income (10,000won) under 3,500 21.17 41.86 14.84*** 62.05 1.01 7.02** 2,928 63.06
over 3,500 14.47 22.46 35.93 1.01 1,715 36.94

Need Factors
  Exercise Problem c No 29.08 48.09 7.92** 75.36 1.81 5.86** 997 22.83
Yes 7.49 15.34 22.58 0.25
  Anxiety/ No 30.69 52.89 0.37 81.85 1.73 1.08 685 16.42
  Depressionc Yes 6.23 10.19 16.18 0.24
  Disability No 33.34 58.65 8.34** 90.01 1.98 4.50**
Yes 2.30 5.71 7.97 0.04
  Chronic Disease No 7.69 13.74 0.03 20.14 1.29 102.43*** 3,648 78.57
Yes 27.76 50.61 77.84 0.73

a Chi-square test between Korean Medicine service users and nonusers

b Chi-square test between Western Medicine service users and nonusers

c Respondents are over 18 years old.

** p<0.01;

*** p<0.001

Table 2.
The Medical Service Use of Respondents
Variables (N or visit or won) %
Outpatients(N) 4,629 99.7
  Korean Medicine Service(N) 1,653 35.6
  Western Medicine Service(N) 4,550 98.0
  Korean and Western Medicine Service(N) 1,573 33.9
  Korean Medicine Service Only(N) 79 1.7
  Western Medicine Service Only(N) 2,976 64.1
Total(N) 4,643 100.0

Korean Medicine service
  Herb Medication(N) 155 9.4
  KM Non Herbal Treatments (N) 1,324 80.1
Total(N) 1,653 100.0

The Mean of Visit Frequency(visit)
   Korean Medicine Service 8.51
   Herb Medication 1.41
   KM Non Herbal Treatments 8.80
  Western Medicine Service 21.17

The Mean of Medical Expenses(won)
  Korean Medicine Service 94,077
  Herb Medication 212,368
   KM Non Herbal Treatments 48,786
  Western Medicine Service 133,045

The Mean of Medical Expenses per visit(won)
  Korean Medicine Service 11,055
  Herb Medication 150,616
  KM Non Herbal Treatments 5,544
  Western Medicine Service 6,285

* Respondents are over 18 years old.

Table 3.
The Logistic Regression Results on WM and KM Service Use in the Patients with Musculoskeletal Disease
Variable Odds Ratio (95% Confidence Interval)

Model I Model II Model III

Dependent Variable
  Western Medicine Service Use

Control Variable
  Sex(Male): Female 1.8367** 1.6048** 1.8712**
  Age(under 45 years):
     over 45-under 55 1.3225 1.2399 1.4191
    over 55-under 65 1.8438 1.8214 1.9916
    over 65 1.3017 1.3345 1.4645
Education (under the middle school graduate): over the high school 2.1052** 1.7713 2.2175**
  Residential Area (outside metropolitan area): metropolitan city 1.3162 1.1704 1.2712
  Household Income(10,000won) (under 3,500):over 3,500 0.8503 0.7832 0.8436
  Exercise Problem(No): Yes 1.0089 1.0535 1.0419
  Anxiety/Depression(No): Yes 1.0277 0.9698 1.0363
  Disability(No): Yes 1.1583 1.1785 1.1397
  Chronic Disease(No): Yes 7.2660*** 6.7457*** 7.3645***

Independent Variables
  Korean Medicine Service Use (No): 0.0989***
  Yes (0.0539,0.1815)
  Herb Medication Use (No): 1.1574
  Yes (0.3541,3.7829)
  KM Non Herbal Treatments Use (No): 0.0692***
  Yes (0.0353,1.1358)

N 4171 4171 4171

Chi-square 163.87*** 83.61*** 182.31***

R Square 0.2031 0.1036 0.2262

* p<0.05;

** p<0.01;

*** p<0.001

Table 4.
The Negative Binominal Regression Results on the Relations between WM Service Visit Frequency and KM Service Use in the Patients with Musculoskeletal Disease
Variable IRR (95% Confidence Interval)

Model I Model II Model III
Dependent Variable
  Western Medicine Service Visit Frequency

Control Variable
  Sex(Male): Female 1.0975*** 1.0961*** 1.0998***
  Age(under 45 years):
    over 45-under 55 1.1361*** 1.1392** 1.1369***
    over 55-under 65 1.4261*** 1.4237*** 1.4248***
    over 65 1.8619*** 1.8612*** 1.8602***
  Education (under the middle school graduate): over the high school 0.9790 0.9758 0.9800
  Residential Area(outside metropolitan area): metropolitan city 0.9700 0.9706 0.9712
  Household Income(10,000won) (under 3,500):over 3,500 0.9553 0.9531 0.9556
  Exercise Problem(No): Yes 1.2617*** 1.2607*** 1.2598***
  Anxiety/Depression(No): Yes 1.1633*** 1.1633*** 1.1636***
  Disability(No): Yes 1.0274*** 1.0268** 1.0275***
  Chronic Disease(No): Yes 2.2262*** 2.2310*** 2.2276***

Independent Variables
  Korean Medicine Service Use (No): 1.0445
  Yes (0.9910,1.1009)
  Herb Medication Use (No): 1.2349***
  Yes (1.0924,1.3959)
  KM Non Herbal Treatments Use (No): 1.0225
  Yes (0.9701,1.0777)

N 4171 4171 4171

Chi-square 1408.79*** 1418.13*** 182.31***

R Square 0.04 0.004 0.2262

* p<0.05;

** p<0.01;

*** p<0.001

Table 5.
The Tobit Regression Results on the Relations between WM Service Expenses and KM Service Use in the Patients with Musculoskeletal Disease
Variable Coefficients (95% Confidence Interval)

Model I Model II Model III

Dependent Variable
  Western Medicine Service Expenses

Control Variable
  Sex(Male): Female 36980*** 35627*** 37017.5***
  Age(under 45 years):
    over 45-under 55 3316 3074 3461.75
    over 55-under 65 28514* 28523 28613.28
    over 65 11443.4 11842 11563.76
  Education (under the middle school graduate): over the high school 32835.74*** 31973.63** 32897.32**
  Residential Area (outside metropolitan area): metropolitan city −4305.15 −4909.328 −4354.149
  Household Income(10,000won) (under 3,500):over 3,500 36559.44*** 35811.22*** 36534.69***
  Exercise Problem(No): Yes 17884.91 18045 18091.4
  Anxiety/Depression(No): Yes 26826.61* 26489.25* 26824.77*
  Disability(No): Yes 8098.441*** 8087.912** 8052.669**
  Chronic Disease(No): Yes 136660.5*** 136363.9*** 136764.7***

Independent Variables
  Korean Medicine Service Use (No): −10209.13
  Yes (−27798,7379)
  Herb Medication Use (No): 26751.68
  Yes (−14293,67796)
  KM Non Herbal Treatments Use (No): −11491.05
  Yes (−29103,6120)

N 4171 4171 4171

Chi-square 206.26*** 206.60*** 206.60

R Square 0.001 0.001 0.001

* p<0.05;

** p<0.01;

*** p<0.001

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