| 摘要: | 背景與動機：為使精神醫療資源獲得更有效的利用，健保局自99年1月開始推出「精神分裂症醫療給付改善方案」，目前，雖有研究對於此方案的施行進行初步的評估，但僅侷限於單一醫院之執行成效評估，尚缺乏不同質性醫院別之比較。
目的：本研究是希望透過健保資料庫的分析，了解不同質性醫院別精神分裂病患參與此方案前後，其精神醫療資源利用之差異，以及是否參與此方案之精神分裂病患，其精神分裂症醫療資源利用之差異，提供後續政策執行之參考。
方法：本研究以國家衛生研究院98年及99年之全民健康保險資料庫100萬抽樣歸人檔，擷取98、99年領有重大傷病卡之精神分裂症(ICD-9-CM 295)患者為研究對象，排除當年度精神科慢性病房住院中病患，及同時領有2(含)張以上不同疾病之重大傷病卡之患者，將資料分為有加入給付改善方案組(實驗組)及未加入給付改善方案組(對照組)兩類，串聯其在精神科門診之處方及治療明細、門診處方醫令及住院醫療費用清單明細等，比較兩組病患其醫療資源耗用情形。
結果：研究結果得知，實驗組99年間門診次數大於8次者佔68.24%，因精神分裂症急診平均次數為1.73次，平均急性病房住院天數為31.21天，精神科門診平均申請金額為2,453.19點；對照組門診次數大於8次者佔64.03%，因精神分裂症急診平均次數為2.37次，平均急性病房住院天數為33.17天，精神科門診平均申請金額為2,783.58點；以t檢定分析99年間實驗組與對照組在精神醫療資源利用之差異，發現實驗組在門診平均就醫次數上顯著高於對照組(p值<0.05)，但其門診平均申請費用卻顯著低於對照組(p值<0.001)；但在比較實驗組在加入給付方案前後之品質指標，則無所差異。
結論：精神分裂症醫療給付改善方案的實施，雖然在門診平均就醫次數及門診申請金額上獲得差異，但在自身品質指標比較卻未如預期，這可能與精神分裂症疾病之複雜性及方案執行時間較短相關，詳細因素有待進一步研究。
Background and Motivation: Since the Bureau of National Health Insurance carried out the “medical payment improvement program for Schizophrenia” in January, 2010, preliminary evaluation for this program is available now, but there is no research of comparison for this program among hospitals.
Objective: By analyzing the National Health Insurance Research Database, the purpose of this study is to understand the differences of medical resources utilization of patients among hospitals after take part in the improvement program, and also the differences of medical resource utilization among patients who take or do not take part in such program. Hoping the results of this study can be the reference in endeavoring to accomplish such program in the future.
Methods: A nationally representative sample of 1,000,000 individuals of health insurance population of Taiwan in 2009 and 2010 is used. The population is patients with catastrophic illness registry due to Schizophrenia (ICD-9 CM 295) in 2010, but those who were hospitalized for chronic mental illness or having more than 2 catastrophic illness cards for different diseases were excluded. All the health institutions of the population mentioned above were divided into two groups, the experimental group and the control group. The prescriptions, treatment details and orders of Psychiatry OPD, and cost details of hospitalization were analyzed to compare the differences of health resource utilization between patients who join or do not join in the program.
Results: In experimental group, the number of OPD visit that exceed 8 in 2010 is 68.24%, the average ER visit caused by Schizophrenia is 1.73, the average hospitalization days for acute wards is 31.21, and the average examination fee applied for Schizophrenia OPD is 2,453.19 points; in control group, the number of OPD visit that exceed 8 is 64.03%, the average ER visit caused by Schizophrenia is 2.37, the average hospitalization days for acute wards is 33.17, and the average examination fee applied for Schizophrenia OPD is 2,783.58 points. t-test was adopted to analyze the difference of medical resource utilization between the experimental group and the control group, and the result is that the number of OPD visit is significant higher in the experimental group (p<0.05), but the average OPD examination fee application is significant lower (p<0.01); however, there is no difference of the quality indicators of the experimental group while comparing them between the before and after periods of joining in the program.
Conclusion: According to the results mentioned above, there are differences of OPD visit and OPD examination fee between hospitals which do or do not participate in the medical payment improvement program for Schizophrenia, while there is no difference of the quality indicators. It may be associated with the complexity of Schizophrenia and the short time for implementation of the program, and its associated factors need further studies. |
