本研究提出並實徵評估一個台灣老人醫療服務使用模式。為反應台灣複雜的醫療服務環境，本模式包括西醫門診、中醫門診、西藥房／局、中藥房、與住院等五個向度的醫療服務使用。利用台灣省家庭計畫研究所1989年台灣地區老人保健與生活問題調查的3846位60歲以上老人資料，及結構公式模式(structural equation modeling)評估本模式，結果發現無論全模式的適合度檢定或各相關參數值的顯著檢定，均能支持此模式之適合性。模式可解釋28%至32%的西醫門診利用變異量，並可解釋12%至15%的西藥房利用變異量。老人中自述較多疾病、自評健康較差、且教育程度較高者較多使用西醫門診服務；男性老人、自述較多疾病、及教育程度較差者較多使用西藥房／局服務；教育程度較低者較多使用中藥房服務，經濟變項雖然對醫療服務使用不具直接影響，但卻能透過自述疾病或自評健康變項間接影響醫療服務之使用。

This study presents and empirically evaluates a structural model of health services utilization among the aged in Taiwan. As a reflection of the medical pluralism in Taiwan, five dimensions of health services utilization are specified involving the use of services provided by: (1) physicians trained in western biomedicine, (2) western pharmacies, (3) physicians trained in traditional Chinese medicine, (4) traditional Chinese drug stores, and (5) hospitals. Data came from the 1989 Survey of Health and Living Status of the Elderly in Taiwan, involving 3,846 respondents. The proposed model was supported in terms of both overall and component goodness-of-fit and estimates of free parameters. 28% to 32% of the variance in the use of health services provided by physicians of biomedicine and 12% to 15% of the variance in the use of services provided by western pharmacies are explained by the model. Study findings indicate that the older Chinese with more self-reported illness, poorer self-rated health, and more education are more likely to utilize physicians of biomedicine. In addition, the male and the elderly with more self-reported illness and less education have a higher propensity to use western pharmacies. The use of Chinese drug stores is negatively related to education. Age is negatively related to the use of hospitals. Finally, there is no direct effect of economic status on utilization, whereas, economic status through its influence on self-reported illness and self-rated health was found to have an indirect effect on utilization.

醫療服務使用 ； 結構公式模式 ； 老人 ； 台灣

Health Services Utilization, Structural Equation Modeling, Aged, Taiwan