摘要
因為受限於智能不足與社會適應之限制，智能障礙者是身心障礙健康較弱勢的一群，他們面臨多就醫的溝通問題，醫療利用也較一般人來得高；許多研究顯示出精神疾病是智能障礙者罹患最多的合併症之一，而國內精神疾病患者也是高醫療資源耗用的族群，但目前國內的醫療保健政策，少有針對罹患精神疾病的智障者分析其醫療使用相關因素之研究。故本研究目的乃在於探討，智能障礙者合併精神疾病利用住院醫療照護情形，以及造成其高醫療耗用的相關因素。研究方法藉由2005年的身心障礙全民健保資料庫，採橫斷性的研究設計，分析其住院醫療費用清單明細檔，探討1,268位合併精神疾病的智障者之住院次數、天數，及其相關醫療耗用。研究結果，合併精神疾病的男性佔58.9%較多；年齡20至39歲合併精神疾病的智障者共佔62.5%；經羅卲斯迴歸校正後發現，合併精神疾病的智障者有較高的住院費用耗用（OR=4.099, 95% CI=3.261-5.153）；發現人口特性影響高醫療耗用因素中以有低收入戶身份耗用較高醫療費用（OR=2.484, 95% CI=1.252-4.929）；而合併兒童期精神疾病的男性智障者有較高的醫療費用耗用（OR=11.558, 95% CI=1.830-73.012）。從研究發現智障者合併精神疾病確實耗用較高的醫療資源，而本研究發現的醫療資源耗用因素，可作為往後醫療衛生單位在照護有雙重診斷的智障者之參考。

Abstract
Aims: This study described and examined the hospital admission care use and medical expenditure among patient with intellectual disability (ID) co-occurring with psychiatric disorders in Taiwan. Methods: A cross-sectional retrospective study was conducted in the study, based on the data of inpatient use and medical expenditures of 2005 national health insurance claims in Taiwan. Results: The main findings of the study revealed that there were 2,565 individuals with ID using hospital inpatient care, and the factors of male (58.9%), 20-39 years old (62.5%) person with ID were more likely to use the psychiatric inpatient care. The logistic regression model analyses found that those ID patient co-occurring with psychiatric disorders (OR=4.099, 95% CI=3.261-5.153), come from low income family (OR=2.484, 95% CI=1.252-4.929), and the male ID patient co-occurring psychoses with origin specific to childhood (OR=11.558, 95% CI=1.830-73.012) consumed more medical expenditure than their counterparts. Conclusions: The study confirmed with previous studies that those people with ID accompanied with dual-diagnosis had used more medical cost than their counterparts. Therefore, the health authorities should pay much attention to the mental health issues of people with ID, to improve their quality of health in psychiatric admissions.

目錄
摘要 VIII
第一章 緒論 1
第一節 問題背景 1
第二節 研究動機與重要性 2
第三節 研究目的 3
第二章 文獻探討 4
第一節 智障者的基本人口特質 4
第二節 罹患精神疾病的健康問題 5
第三節 精神疾病的醫療耗用問題 8
第三章 研究方法與步驟 12
第一節 研究架構 12
第二節 研究假設 13
第三節 名詞解釋 13
第三節 研究工具 14
第四節 研究方法 15
第五節 研究對象 15
第六節 資料處理與分析 16
第四章 研究結果 19
第一節 智能障礙者罹患精神疾病情形 19
第二節 智能障礙者罹患精神分裂 24
第三節 智能障礙者罹患其他器質性精神病態（慢性） 26
第四節 智能障礙者罹患慢性情感性精神病 27
第五節 智能障礙罹患源於兒童期之精神病 29
第五章 討論 31
第一節 智能障礙者罹患精神疾病情形 31
第二節 智障者罹患精神病的住院服務之醫療利用情形 32
第三節 智障者罹患不同精神病的醫療耗用分析 33
第四節 影響智障者罹患精神疾病的醫療耗用之相關因素 36
第五節 研究限制 39
第六章 結論與建議 40
參考文獻 43


附錄一、表格目錄
表1. 智能障礙者合併相關精神疾病之住院人口 53
表2. 智能障礙者合併精神疾病的就醫醫院權屬別分布情形（人次） 54
表3. 智能障礙者住院之基本人口學特性分析 55
表4. 智能障礙者的相關住院醫療耗用 56
表5. 智能障礙者有無合併精神疾病之住院基本人口學特性比較 57
表6. 智能障礙者有無合併精神疾病之住院醫療相關費用比較 58
表7. 智能障礙者住院費用高低與住院基本人口學特性之羅吉斯迴歸 59
表8. 智能障礙者住院天數高低與住院基本人口學特性之羅吉斯迴歸 60
表9. 智能障礙者合併精神疾病之住院基本人口學特性分析 61
表10. 智能障礙者合併精神疾病的相關住院醫療耗用 62
表11. 智能障礙者合併精神疾病的住院醫療費用高低與基本人口學特性之比較 63
表12. 智能障礙者合併精神疾病的住院醫療費用與基本人口學特性之比較 64
表13. 智能障礙者合併精神疾病之住院醫療費用影響因素複迴歸分析 65
表14. 智障者合併精神疾病的住院醫療費用高低與基本人口學特性之羅吉斯迴歸 66
表15. 智能障礙者合併精神分裂之住院基本人口學特性分析 67
表16. 智能障礙者合併精神分裂的相關住院醫療耗用 68
表17. 智能障礙者合併精神分裂的住院醫療費用高低與基本人口學特性之比較 69
表18. 智能障礙者合併精神分裂的住院醫療費用與基本人口學特性之比較 70
表19. 智能障礙者合併精神分裂之住院醫療費用影響因素複迴歸分析 71
表20. 智能障礙者合併精神分裂的住院醫療費用高低與基本人口學特性之羅吉斯迴歸 72
表21. 智能障礙者合併其他器質性精神病態之住院基本人口學特性分析 73
表22. 智能障礙者合併其他器質性精神病態的相關住院醫療耗用 74
表23. 智能障礙者合併其他器質性精神病態的住院醫療費用高低與基本人口學特性之比較 75
表24. 智能障礙者合併其他器質性精神病態的住院醫療費用與基本人口學特性之比較 76
表25. 智能障礙者合併其他器質性精神病態的住院醫療費用影響因素複迴歸分析 77
表26. 智能障礙者合併其他器質性精神病態的住院醫療費用高低與基本人口學變項之羅吉斯迴歸 78
表27. 智能障礙者合併情感性精神病之住院基本人口學特性分析 79
表28. 智能障礙者合併情感性精神病的相關住院醫療耗用 80
表29. 智能障礙者合併情感性精神病的住院醫療費用高低與基本人口學特性之比較 81
表30. 智能障礙者合併情感性精神病的住院醫療費用與基本人口學特性之比較 82
表31. 智能障礙者合併情感性精神病的住院醫療費用影響因素複迴歸分析 83
表32. 智能障礙者合併情感性精神病的住院醫療費用高低與基本人口學特性之羅吉斯迴歸 84
表33. 智能障礙者合併源於兒童期精神病之住院基本人口學特性分析 85
表34. 智能障礙者合併源於兒童期精神病的相關住院醫療耗用 86
表35. 智障者合併源於兒童期精神病的住院醫療費用高低與基本人口學特性之比較 87
表36. 智能障礙者合併源於兒童期精神病的住院醫療費用與基本人口學特性之比較 88
表37. 智能障礙者合併源於兒童期精神病的住院醫療費用影響因素複迴歸分析 89
表38. 智障者合併源於兒童期精神病的住院醫療費用高低與基本人口學變項之羅吉斯迴歸 90


附錄二、圖目錄
圖1. 智能障礙者合併精神分裂症之病別細項 91
圖2. 智能障礙者合併其他器質性精神病態(慢性)之病別細項 92
圖3. 智能障礙者合併情感性精神病之病別細項 93
圖4. 智能障礙者合併源於兒童期精神病之病別細項 94

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