| 摘要: | 根據世界衛生組織等的研究中發現，平均每一百人中就有三人罹患憂鬱症(WHO,2001)。美國心理衛生研究院(National Institute of Mental Health, NIMH,2002)的研究報告指出約4%至18%的西方人在一生當中，至少曾出現一次的憂鬱症狀，其中 50%至85%會再發生至少一次，而美國人憂鬱症的終生盛行率更高達15%！ 此外，聯合國世界衛生組織(WHO)更指出公元2020年時，憂鬱症將名列造成人類失能疾病的第二位(WHO,2002)。 本研究使用國家衛生研究院全民健保資料庫1996-2000年共10萬人之歸人檔資料庫，依ICD-9-CM碼經醫師診斷為300.4、296.2、296.3、296.5、309及311， A-code為A212、A214及A219的憂鬱症患者進行醫療費用與醫療服務使用情形之分析。 研究重要結果如下： 一、民國89年女性憂鬱症疾病門診次數高於男性，且在各年齡別均有統計上的差異。 二、 1996-2000年憂鬱症疾病就醫科別中，到精神科就診的門診次數佔率依序為44.7%、44.6%、50.6%、51.2%、65.3%，呈現上升的趨勢。 三、民國88年台灣921地震及後一年(民國89年)憂鬱症疾病的門診、急診、住院醫療利用量均較民國85年至87年大幅下降。 四、 民國89年之憂鬱症門診平均次數以中區分局最高(10.29次)。 五、自民國85年到89年，不管在門診、急診或住院方面，所耗費醫療費用均逐年成長。 六、憂鬱症疾病的就醫層級在各年都以基層診所的比率最高。 七、民國89年醫學中心、區域醫院、地區醫院、基層診所平均每診給藥日份依序為22.98天、20.10天、16.30天、9.90天。 本研究之建議如下： 一、 健保局於審查申報案件時，應嚴格要求各醫療機構申報ICD-9-CM碼的正確性，避免混淆疾病的相關統計。 二、 憂鬱症患者就醫比率偏低 本研究統計民國85至民國89年憂鬱症疾病接受醫療服務的比率，最高只佔十萬人中的2.3%，此數據與WHO所公佈的憂鬱症盛行率3%仍有很大的差距。 三、 建議健保局制訂醫師開立憂鬱症治療藥物規定時，應廣泛採納精神科專科醫師的建議，適時加以修正。; According to the reports of the World Health Organization (WHO), it discovered that the numbers of people who had depression disorders problem were three in a hundred in 2001. The depression disorders problem might bring the body illness and completely destruction. In 2002, the National Institute of Mental Health (NIMH) pointed out that the numbers of Western people who had a depression disorders problem were between 4 % to 18% in their lifetime and the chance rate to have depression disorders problem once was between 50% and 85 %. Moreover, the Americans had the depression disorders problem were up to 15 % during their lifetime. The reactions of depression disorders problem could cause the body illness, unemployed, social problem, and the relationships between the people, even suicide and injury. Furthermore, it could increase the costs of the patients, patients’ family and society. Therefore, the WHO pointed that the depression disorders problem would be the second place of the cause of human disability disease in 2020. It was an important subject to understand that the cost control of the resources of medical treatment for NHI. It might be a contribution for the resource of NHI, if analyzed and practiced the use rate of the patients of depression disorders problem. This study was used the National Health Insurance Registry for 100,000 Beneficiaries Claims Data Files from 1996 to 2000. According to ICD-9-CM, the doctor diagnosed 300.4, 296.2, 296.3, 309 and 311. Moreover, analyzed the medical treatment fee and medical treatment service for the patients of the depression disorders of A212, A214 and A219 in A-code. The results were concluded as follows: 1. The demographic characteristic Female utilized more ambulatory care of depression disorders visits than male in 2000. 2. The utilizing rates of depression disorders beneficiaries in ambulatory care of psychiatric department were revealed increased. 3. The annual total depression disorders utility frequency differences before and after 921 earthquake After 921 earthquake, the annual total utility frequency of depression disorders revealed decreased. 4. The annual total medicine costs in ambulatory care, emergency care, and inpatient care all increased from 1996 to 2000. 5. The utilization rate of services offered by basic clinics by depression patients was apparently the highest in the four medical levels. 6. The average number of medicine offering days for ambulatory care by medical center 22.98 was the most, and the basic clinics 9.90 was the least. |
