| 摘要: | 動機與目的：
近來精神疾病住院患者門診醫療利用次數及費用逐年成長，如能就精神疾病住院患者的醫療使用率及影響因素加以分析，應能為有限的健保資源利用及醫院管理方面做出建議與貢獻。本研究旨在探討精神疾病患者中、西醫門診醫療利用情形，並以Aday and Andersen醫療服務行為模式，來分析其影響因素。
研究方法：
採用全民健康保險學術研究資料庫「2002年至2007年精神疾病住院病患歸人檔」作為研究對象，有效樣本為95,435人，並使用描述性分析、Student t-test、單因子變異數分析、複迴歸分析，以探討精神疾病患者中、西醫門診醫療利用情形與相關影響因子。
結果與結論：
全體研究對象之利用中醫門診比率為24.47%，每人每年平均中醫門診利用次數為1.57次，每人每年平均醫療費用為138.78元；全體研究對象之利用西醫門診比率為80.55%，每人每年平均西醫門診利用次數為19.02次，每人每年平均醫療費用為1179.76元。
1. 中醫門診醫療利用影響因素：
在傾向因素方面，男性之中醫門診醫療利用次數高於女性；年齡層在21-30歲之中醫門診醫療利用較高。
在能用因素方面，投保金額在四萬元以上之中醫門診醫療利用次數較低；投保地區為臺中市之中醫門診醫療利用較高；每萬人口西醫師數為24.01名以上之中醫門診醫療利用次數及12.01-24.00名之中醫門診醫療費用較高；每萬人口精神科醫師數0.50名以下之中醫門診醫療利用較高；低收入戶者之中醫門診醫療利用次數較高；需部分負擔者之中醫門診醫療費用較低。
在需要因素方面，是否有重大傷病之中醫門診醫療利用未顯著。
2. 西醫門診醫療利用影響因素：
在傾向因素方面，男性之西醫門診醫療利用較女性高；21-30歲之西醫門診醫療利用較高；投保身分為受雇者之西醫門診醫療利用較高。
在能用因素方面，投保金額為10,001-20,000元之西醫門診醫療利用較高；投保地區為澎湖縣之西醫門診醫療利用次數及投保地區為台北市之西醫門診醫療費用較高；每萬人口西醫師數為24.01名以上之西醫門診醫療利用次數及每萬人口西醫師數12.01-24.00名之西醫門診醫療費用較高；每萬人口中醫師數為1.01-1.50名及1.51名以上之西醫門診醫療利用次數較高；每萬人口精神科醫師數為0.50名以下之西醫門診醫療利用較高；低收入戶者之西醫門診醫療利用較高；免部分負擔之西醫門診醫療利用較高。
在需要因素方面，有重大傷病之西醫門診醫療利用較高。
建議：
本研究對醫療政策方面建議：（1）鼓勵精神疾病住院患者多加使用中醫門診醫療；（2）強化精神疾病住院患者門診醫療品質；（3）深入調查精神疾病住院病患是否有過度醫療利用；（4）針對年輕精神病患族群進行妥善健康管理。
中、西醫醫療管理方面建議：（1）拓展中、西醫醫療市場，吸引顧客持續使用；（2）中、西醫門診醫療應建立整合性照顧模式；（3）建立臨床指引與門診、住院照護臨床路徑；（4）落實精神疾病個案管理制度。
Background and Objectives
Recently the ambulatory visits and ambulatory expenditures of psychiatric patients have gradually grown. By analyzing psychiatric patients’ medical utilization as well as relevant influence factors, we can make sufficient contributions to healthcare resources utilization and hospital management. The main goals of this paper are to discuss the ambulatory utilization of Chinese and Western medicine in psychiatric patients and to adopt Aday and Andersen’s health behavior model to analyze associated influence factors.
Research Method
The 95,435 valid samples were selected from Psychiatric Inpatient Medical claim dataset (PIMC) from 2002 to 2007. In addition of descriptive analysis, Student t-test, One-Way ANOVA, we also used linear regression model to explore the utilization of ambulatory Chinese and Western medical services in psychiatric patients and associated factors.
Results and Conclusion
24.47% of all samples have utilized ambulatory Chinese medical services in 2008. Average utilization rate of ambulatory Chinese medical services was 1.57 per person per year and average ambulatory expenditure of thess was 138.78 dollars per person per year. With regarding to Western medical services, 80.55% of the insured have utilized ambulatory Western medicine, average ambulatory visits of Western medicine was 19.02 per person per year, and average ambulatory expenditure of Western medicine was 1179.76 dollars per person per year.
1. Factors affecting ambulatory Chinese Medical services:
Males utilize more ambulatory Chinese medical service visits than females. People aged between 21 and 30 utilize more ambulatory visits and ambulatory expenditures of Chinese medicine than other ages. Persons with insured amount over $40000 have lower ambulatory Chinese medicine visits than others. In regions with more Western medicine doctors, people tend to utilize more Chinese medicine services. In regions with fewer Psychiatric doctors, people tend to have more ambulatory Chinese medicine visits and expenditures. Persons with low-income household or persons with exemptions of copayment use more Chinese medical services than others.
2. Factors affecting ambulatory Western Medical services:
Males have more ambulatory Western medical services visits and expenditures than females. People aged between 21 and 30 utilize more ambulatory visits and ambulatory expenditures of Western medicine than other ages. Persons with insured amount between $10000 and $20000 have more ambulatory Western medicine visits and expenditures than others. In regions with more Western medicine doctors, people tend to utilize more Western medicine services. In regions with more Chinese medicine doctors, people tend to utilize more Western medicine services. However, in regions with fewer Psychiatric doctors, people tend to have more ambulatory Western medicine visits and expenditures. Persons with low-income household, with exemptions of copayment or with catastrophic illnese use more Western medical services than others.
Recommendations
Our recommendations for the health policy are: encouraging psychiatric patients to use ambulatory Chinese medical services; enhancing the qulity of ambulatory care for psychiatric patients; investigating whether the problem of excessive medical utilization existed in psychiatric patients; conducting proper health management for young psychiatric patients.
Suggestions for Health Services Management are: expanding Chinese and Western medicine market and attracting customers to use them continuously; establishing the integrated care model of ambulatory Chinese and Western medical servicesl; establishing clinical guidelines and ambulatory and inpatient clinical path; implementing case management for psychiatric patients. |
