Student : I-Ju Yang Advisor : Clyde A. Warden Ph.D.

1. Chinese and Western Medical Treatment in Taiwan: Experience and Framing Influence on Consumer Choice Values Student : I-Ju Yang Advisor : Clyde A. Warden Ph.D.

2. Contents • Introduction • Literature Review & Hypotheses • Hospital Choice Factors • Behavior Intention • Thought and Practice • Attitude and Belief • Framing • Methodology • Results • Discussion & Implications

3. Introduction • More health conscious and better informed leading to increased consideration of hospital choice factors. • 31.3% growth of Traditional Chinese Medicine (TCM) clinics manifests a increasing demand over 1994. • Hospital choice factors typically were based on hospital type, type of care, and choice influencers. Little is known about consumers’ perceived importance of TCM compared to Western medicine paradigms.

4. Research Purpose • How consumers expected TCM and Western hospitals/clinics across hospital selection criteria. • How consumers with different experiences rate TCM and Western hospitals/clinics across choice factors as well as difference.

5. Literature Review

6. Hospital Choice Factors • Boscarino and Steiber (1982): • Nearest to Home – convenience • Doctor uses • Specialist doctors • Best equipment or technology • Quality of facility • Know/like staff • Past experience • Less expensive • Size • Religious affiliation

7. Hospital Choice Factors • Wolinsky and Kurz (1986): • Knowledge • Cost • Quality • Recommendations • National Research Corporation (1986): 1. Medical staff quality 2. Closeness to home

8. Hospital Choice Factors • Lane and Lindquist (1998): • Care  Experience • Physical facilities  Clientele • Staff  Convenience • Institutional • Bishop(1991), Chang (1983), Wu & Hu(1980): • Waiting time • Treatment time

9. Behavioral Intention: TCM and Western Medicine • Chang et al. (1996) • No hope • About to die TCM • Health care selection stages (Chou,2001): • Early stage: Self diagnosis/home care • Moderate illness: Call on clinics or hospitals • Overt symptoms: Western medicine

10. Behavioral Intention: TCM and Western Medicine • Muscle sprain • Joint dislocation • Muscle ache TCM • Illness requiring bed rest • Endocrine disease • Metabolic disease Western medicine • Chou (2001): Clinic type between TCM and Western medicine among dual utilizers

11. Behavioral Intention: TCM and Western Medicine • Ill-defined condition • Musculoskeletal system • Connective tissue TCM • Respiratory infections • Bronchitis • hypertensive disease Western medicine • Department of Health (2003):

12. Thought and Practice:TCM and Western Medicine Thought of Western Medicine • Jianping and Rose (2002): Western medicine relied on rigorous scientific studies and research that sought empirical proof to all phenomena. Its health care was very materialistic.

13. Thought and Practice:TCM and Western Medicine Thought of TCM • Jianping and Rose (2002): TCM was possessed of a distinct and coherent method • Relative holism • Differentiation of patterns to determine treatment • Therapy delivered through natural substances • Human relationship between doctor and patient • A comprehensive

14. Hypotheses 1 • Consumers’ understanding of illness would affect the treatment. • Previous hospital visits represent a consumer’s value of TCM or Western treatment. H1a: High familiarity with TCM treatment consumers will rate higher importance on choice factors of TCM hospitals/clinics higher than those of Western hospitals/clinics. H1b: High familiarity with Western treatment consumers will rate higher importance on choice factors of Western hospitals/clinics higher than those of TCM hospitals/clinics.

15. Hypotheses 2 • A great amount of Western medicine utilizers, TCM treatment consumers revealed an increasing tendency. • Shih (1996): Chinese patients believing a combination of both TCM and Western medicine providing the best treatment. H2: High familiarity with TCM treatment consumers will rate higher importance on choice factors of TCM hospitals/clinics higher than those of Western hospitals/clinics.

16. Hypotheses 3 • Pillay (1996): Culture influences on Chinese health beliefs to involve more in health care and disease prevention. • Gochman (1988): Medical practitioners were normally the last choice for patients. H3: Low familiarity with TCM treatment consumers will rate higher importance on choice factors of TCM hospitals/clinics higher than those of Western hospitals/clinics.

17. Framing • Framing effects: The finding that decision makers respond differently to different but objectively equivalent description of the same problem. • Levin et al. (1998): for attribute framing effects , positive attribute frames evoked favorable associations in memory and encourage the recruitment of positive information.

18. Attitude and beliefs:TCM and Western medicine Chou (2001) found half of his subjects disagreed with: • Diagnostic accuracy of Western medicine was better than TCM. • TCM doctors explained more detail than Western medical doctors do. • Cost in modern medicines was often more expensive than that in TCM. • When talking to patients, TCM doctors were more friendly.

19. Attitude and beliefs:TCM and Western • Younger males with • higher education Western medicine • Order, not well • educated • Wealthy female TCM • Chan et al. (2003): for Hong Kong Chinese

20. Hypotheses 4 • With perceived advantages to both TCM and Western medicine treatment, consumers might be influenced in their attitude by the context or frame of the situation. H4: Consumers responding to a TCM frame will rate importance of choice factors differently than consumers respond to a Western medicine frame.

21. Methodology

22. Manipulation and Measurement • Treatment experience: Frequency of visiting TCM and Western medicine hospitals/clinics in 1, 6, and 12 months. • Attribute framing: Subjects were randomly assigned to the attribute framing of TCM or Western medicine hospitals/clinics.

23. Manipulation and Measurement Hospital choice factors: • Time • Convenience • Staff • Physical facilities • Cost • Cost • Clientele • Institutional • Care

24. Data Collection • A banner located on yam, TrustMed.com, and Goolu.com with a gift return for online survey in December, 2004

25. Procedures Expectation on hospital choice factors towards TCM hospitals/clinics Frequency of visiting TCM & Western hospitals/clinics Responses of demographics Expectation on hospital choice factors towards Western hospitals/clinics Computer assisted survey instrument (CASI)

26. Participants & Analysis • 469 respondents: • 236 of TCM hospitals/clinics respondents, 239 of Western hospitals/clinics • 70 % female, 30 % male • Mean age of 29 • Data analyses: SPSS-10.0 MANOVA

27. Results

28. Results • Multivariate test not significant in Treatment experience and Framing • Interaction effects between Treatment experience and Framing  Partial support for H4

29. Results (con.)

30. Results (con.) • Nonsignificant multivariate test due to treatment experience, framing and interaction Support H2 • Multiple comparisons among treatment experiences by afftibute framing of TCM and Western hospitals/clinics revealed significant differences only on Western hospitals.  Partial Support H3

31. Discussion

32. Discussion • The attribute framing manipulation leading to an interaction with treatment. • In the process of modernization, the operating mode of TCM hospitals/clinics is more likely Western medicine hospitals/clinics.

33. Discussion

34. Discussion

35. Discussion - Less Familiarity with TCM TCM hospitals/clinics + High Familiarity with TCM + Western hospitals/clinics Western medicine Frame Treatment Experience Framing

36. Implications • For health care management: Set up a TCM outpatient in Western medicine hospitals/clinics to maximize profit. • For patients: Ensure patients’ safety of drug interaction. • For researchers: Be aware of the profound influences of framing when studying medical behavior.

37. Thanks for your listening