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題名：台灣老人精神疾病住院病人醫療利用之趨勢研究
作者：劉金明
作者(外文)：Chin-ming Liu
校院名稱：逢甲大學
系所名稱：商學研究所
指導教授：劉純之
利菊秀
學位類別：博士
出版日期：2012
主題關鍵詞：醫療利用率；精神疾病住院病人；全民健康保險；住院費用；住院天數；趨勢；healthcare utilization；National Health Insurance；trend；psychogeriatric inpatients；length of stay；direct medical cost
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The first essay analyzes the mental healthcare utilization of the psychogeriatric inpatients who admitted to psychiatric ward during year 2002 during six-year period (2002-2007). The Psychiatric Inpatient Medical Claim dataset (PSY2, 2002-2007) which are provided by National Health Research Institute is used for investigation. After data processing and analyzing, we find that mean length of stay (LOS) and direct medical costs (DMC) are significantly different according to gender, psychiatric diagnosis, institution type, ownership type, and number of hospitalizations. Factors significantly associated with longer LOS and higher DMC are: male gender; Schizophrenic and Delusional disorders; and public institution. Affective disorders have shorter LOS but higher DMC than Dementia inpatients. Community and psychiatric hospitals, compared to general hospitals, significantly influenced LOS but not DMC.
The second essay examines the trends of changes in LOS and DMC of psychiatric services utilization among elder people in Taiwan between 2002 and 2006. The trends of LOS and DMC show upward tendency between 2002 and 2006. LOS and DMC of male inpatients are always higher than that of female inpatients. The three major geriatric mental disorders, dementia, schizophrenia, and affective disorders present in the similar increasing pattern and all with gender differences, but only one reverse point for schizophrenia in 2005.
The third essay focuses on the long-stay or overstay (LOS of two years and longer) psychiatric inpatients that are always neglected and excluded in previous study. The Psychiatric Inpatient Medical Claim dataset (PSY1, 1996-2001, and PSY2, 2002-2007) are combined and used for studying. The omit portion of annual mean LOS and DMC in previous studies which are made by psychiatric overstay inpatients can be used to measure the degree of bias of annual LOS and DMC. Furthermore, the characteristics of overstay inpatients, such as age, gender, diagnosis, hospital level, and correlation with duration and DMC can be figured out with detail.
In sum, the trends and amount of healthcare utilizations by psychogeriatric inpatients show increase tendency and increment pattern. As population in Taiwan become older, geriatric people will obviously become a substantial part of healthcare consumptions. Action plan should be made to control financial imbalance of NHI and, simultaneously, to provide good quality of mental healthcare.
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