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研究生:簡以嘉
研究生(外文):I-Chia Chien
論文名稱:台灣全民健保精神疾病盛行率、醫療利用及費用分析研究
論文名稱(外文):Prevalence, Use, and Costs of Psychiatric Disorders Among National Health Insurance Enrollees in Taiwan
指導教授:周碧瑟周碧瑟引用關係
指導教授(外文):Pesus Chou
學位類別:博士
校院名稱:國立陽明大學
系所名稱:公共衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:英文
論文頁數:172
中文關鍵詞:盛行率醫療利用費用精神疾病全民健保台灣
外文關鍵詞:prevalenceusecostspsychiatric disordernational health insuranceTaiwan
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目的:公元2000年已有96%的台灣民眾加入全民健保。我們可以用全民健保資料檔來研究精神疾病盛行率、醫療利用及費用。我們也用1996至2001年的資料來分析精神分裂症盛行率及發生率。
方法:國家衛生研究院釋出全民健保全體納保人1%抽樣檔約200,432人,供研究使用。精神疾病盛行率研究排除18歲以下及2000年未納保者,共納入樣本137,914人來進行研究,以2000年全民健保精神疾病盛行率和1985年社區研究盛行率做比較,觀察15年間的變化。在精神疾病醫療利用及費用的研究,我們排除外國人、2000年未全年納保者以及18歲以下者,共納入樣本126,146人,分成沒有精神疾病、輕型精神疾病、重型精神疾病無重病卡以及重型精神疾有重病卡四組來進行研究,探討精神醫療及非精神醫療之醫療利用、費用及影響之相關因子。同時,我們也取得136,045個樣本做為1996-2001年固定世代追蹤研究,檢視這六年中在門診或住院主診斷為精神分裂症者的盛行率及發生率。
結果:重型精神疾病、輕型精神疾病及精神疾病之一年盛行率為分別1.37%、4.26%及5.36%。盛行率有性別差異的包括5種重型精神疾病及9種輕型精神疾病。2000年全民健保精神疾病盛行率有8種精神疾病盛行率較1985年社區研究為低。只有精神分裂症盛行率在2000年全民健保的研究較高,而躁鬱症盛行率則二個研究相同。在2000年精神醫療費用方面,以美元計算,輕型精神疾病、重型精神疾病無重病卡以及重型精神疾有重病卡者分別為$84.8 (SE 14.8), $410.3 (SE 33.3), 以及$2151.6 (SE 39.5);在2000年非精神醫療費用方面,以美元計算,沒有精神疾病、輕型精神疾病、重型精神疾病無重病卡以及重型精神疾有重病卡者分別為$484.2 (SE 4.6), $739.2 (SE 22.0), $941.0 (SE 49.3), 以及$605.9 (SE 58.0)。在精神分裂症盛行率及發生率研究,1996至2001年累積盛行率,從每千人3.34增加至6.42;1997至2001年年發生率,從每千人0.95減少至6.42。男性在年輕的年齡組較女性有較高的精神分裂症盛行率。25-44歲年齡組、45-64歲年齡組、投保金額低於640美元、以及居住於東部及郊區者有較高的精神分裂症盛行率。45-64歲年齡組有較低精神分裂症發生率;投保金額低於640美元以及居住於東部者有較高精神分裂症發生率。
結論:因為2000年全民健保精神疾病盛行率研究及1985年社區精神疾病盛行率研究較其他國家為低,我們推論台灣重型精神疾病及輕型精神疾病患者均未接受足夠的治療。重型精神疾病患者較輕型精神疾病患者有較高的精神醫療利用及費用;重型精神疾病無重病卡患者及輕型精神疾病患者較沒有精神疾病者有較高的非精神醫療利用及費用。我們必須重視精神疾病的教育、預防及治療,也必須重視精神疾病患者的一般健康照護。依據累積盛行率及發生密度趨勢,全民健保精神分裂症盛行率及發生率與社區的研究將逐漸接近。大部分精神分裂症患者在全民健保實施後已接受治療,未來研究可集中於結果及費用評估。
Objective: 96% of all residents of Taiwan in 2000 were enrolled in the National Health Insurance (NHI) program. The NHI database was used to detect the prevalence, use and costs of psychiatric disorders. We also used the NHI database from 1996 to 2001 to examine the prevalence and incidence of schizoprenia.
Methods: The National Health Research Institute of Taiwan offered a database of 200,432 random subjects, about 1% of the population, for use in related studies. Persons under the age of 18 years and persons who were not eligible for NHI in 2000 were excluded, leaving 137,914 persons available for this study. Data from the 2000 NHI study were compared with data from a 1985 community survey (Taiwan Psychiatric Epidemiological Project) to determine how the prevalence rates of psychiatric disorders changed over the 15-year period. Besides, considering the use and costs, the enrollees were excluded if they were foreigners, or if they had not been continuously eligible and alive for all of the year 2000. Subjects were also limited to those age 18 and older. So, we analyzed 126,146 subjects, who were divided into four groups: no psychiatric disorder, minor psychiatric disorder, and major psychiatric disorder without or with catastrophic illness registration. Outcome measures also included mental and non-mental health care use and costs and their associated factors. Also, by means of exclusion criteria, we obtained a random sample of 136,045 subjects as a fixed cohort dated 1996–2001. Those study subjects who had at least one service claim during these years for either ambulatory or inpatient care, with a principal diagnosis of schizophrenia, were identified to study the prevalence and incidence.
Results: The one-year prevalence rate of any major psychiatric disorder, any minor psychiatric disorder, and any psychiatric disorder was 1.37 percent, 4.26 percent, and 5.30 percent, respectively. The differences in prevalence rates between the sexes were significant for five major and nine minor psychiatric disorders. The prevalence rates for eight psychiatric disorders were lower in the 2000 NHI study than in the 1985 community survey. However, the prevalence rate of schizophrenic disorder was found to be higher in the 2000 study and the prevalence rate of bipolar disorder was found to be the same in both studies. The mean mental health care costs (US$) and standard errors (SEs) of minor psychiatric disorder, and major psychiatric disorder without or with catastrophic illness registration in 2000 were $84.8 (SE 14.8), $410.3 (SE 33.3), and $2151.6 (SE 39.5), respectively. The mean non-mental health care costs (US$) and SEs of no psychiatric disorder, minor psychiatric disorder, and major psychiatric disorder without or with catastrophic illness registration were $484.2 (SE 4.6), $739.2 (SE 22.0), $941.0 (SE 49.3), and $605.9 (SE 58.0), respectively. The cumulative prevalence of schizophrenia increased from 3.34 per 1000 to 6.42 per1000 from 1996 to 2001. The annual incidence density decreased from 0.95 per 1000 per year to 0.45 per 1000 per year from 1997 to 2001. Male subjects had higher treated prevalence in younger age groups than did female subjects. Higher prevalence was associated with the 25–44 and 45–64 age groups, insurance amount less than US$640, the eastern region, and suburban areas. Lower incidence was associated with 45–64 age group. Higher incidence was associated with insurance amount less than US$640, and the eastern region.
Conclusions: Because the prevalence rates of psychiatric disorders were generally lower in this study and in the 1985 community survey than those in other countries, it was concluded that both major and minor psychiatric disorders were undertreated in Taiwan. Persons with major psychiatric disorder have higher mental health care use and costs than those with minor psychiatric disorder. Persons with minor psychiatric disorder, or major psychiatric disorder without catastrophic illness registration also have higher non-mental health care use and costs than those without psychiatric disorder. We must emphasize the mental illness education, prevention, and treatment, and the general health care of persons with psychiatric disorders is also important. According to the trends of cumulative prevalence and incidence density, the treated prevalence and incidence rate of schizophrenia will be approximate to community rates gradually. Most persons with schizophrenia had received treatment in Taiwan after the NHI program was implemented. Future studies should focus on outcome and cost evaluation.
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