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題名:精神疾病患者出院後門診追蹤與轉介精神復健機構治療之成本效益分析
書刊名:臺灣公共衛生雜誌
作者:蔡毓瑄秦文鎮張永源
作者(外文):Tsai, Yu-hsuanChin, Wen-chengChang, Yong-yuan
出版日期:2014
卷期:33:2
頁次:頁150-161
主題關鍵詞:精神疾病患者精神復健機構成本效益分析傾向分數配對Psychiatric patientsInstitution of psychiatric rehabilitationCost-benefit analysisPropensity score matching
原始連結:連回原系統網址new window
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  • 被引用次數被引用次數:期刊(1) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:1
  • 共同引用共同引用:13
  • 點閱點閱:105
目標:針對精神病患出院後門診追蹤與轉介精神復健機構治療之成本效益進行探討。方法:採全民健保資料庫2000年百萬歸人檔資料,篩選2004年1月1日至2008年12月31日期間,首次於精神科出院之病患,將出院病患分為門診追蹤治療組與精神復健治療組,針對病患出院後2年期間之醫療資源使用,以卡方檢定、獨立樣本t檢定、二項對數迴歸分析及成本效益評估指標,進行成本效益分析。結果:本研究以健康保險支付者為觀點,採醫療直接成本,以申報點數加以計算,經傾向分數配對,兩組各取326人為研究樣本,結果發現,門診追蹤治療的成本效益優於精神復健治療。結論:精神復健治療與門診追蹤治療相較,雖未有明顯的成本效益之優勢,但由精神科住院醫療費用統計資料發現,門診追蹤治療組不論在平均醫療費用或總醫療費用部分,第二年均較第一年增加,因此,建議拉長追蹤年數,以瞭解兩組成本效益之趨勢變化。
Objectives: This study investigated the cost-benefit analysis of psychiatric patients discharged from hospitals and either followed-up in outpatient departments or transferred to institutions for psychiatric rehabilitation. Methods: The data were obtained from the Normalized Million People File on 2000, National Health Insurance Research Database. We selected psychiatric in-patients who were discharged from 2004.1.1 ~ 2008.12.31. The cases were divided into a group that received outpatient follow-up and a group which had psychiatric rehabilitation. We investigated the cost-benefit analysis of these two groups within 2 years after discharge, using chi-square t-tests, independent t-tests, binary logistic regression analysis, and the indicators of cost-benefit analysis. Results: From the point of view of health insurance payers, the costs were direct and analyzed by reporting points of NHI. By using propensity score matching, we selected 326 cases from each group for study. From the indicators of cost-benefit analysis, we found that the cost-benefit of the group with outpatient follow-up was better than that of psychiatric rehabilitation group. Conclusions: There was no advantage in cost-benefit for the group with psychiatric rehabilitation compared with the group with outpatient follow-up. But for the group in outpatient follow-up, average and total medical expenses in the second year were higher than the expenses in the first year. A future study that prolonged the years of follow-up may clarify the trends in these two groups.
期刊論文
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4.Carney, C. P.、Jones, L.、Woolson, R. F.(2006)。Medical comorbidity in women and men with schizophrenia: a population-based controlled study。Journal of General Internal Medicine,21(11),1133-1137。  new window
5.Herr, B.E.、Anderson, W.(1991)。Length of stay in a general hospital psychiatry unit。Gen Hosp Psychiatry,13,68-70。  new window
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10.吳希文、楊銘欽(20120600)。精神分裂症病患三種社區精神復健模式之醫療利用分析。臺灣職能治療研究與實務雜誌,8(1),1-14。new window  延伸查詢new window
11.彭英傑、陳端容(20050400)。醫院擴增不同型態精神醫療資源之影響因素探討。臺灣公共衛生雜誌,24(2),162-172。new window  延伸查詢new window
12.黃青青、索任、楊銘欽、江大雄、林立人(20031000)。高雄縣結核病例改診斷評估及其成本效益分析。臺灣公共衛生雜誌,22(5),368-375。new window  延伸查詢new window
13.蔡世仁、陳展航、沈楚文(19960300)。一所公立醫學中心精神科住院病患之分析。慈濟醫學,8(1),55-59。  延伸查詢new window
14.Knapp, M.、Chisholm, D.、Leese, M.、Amaddeo, F.、Tansella, M.、Becker, T.(2002)。Comparing patterns and costs of schizophrenia care in five European countries: the EPSILON study。Acta Psychiatric Sand.,105,42-54。  new window
15.Rothbard, A. B.、Kuno, E.、Schinnar, A. P.、Hadley, T. R.、Turk, R.(1999)。Service Utilization and Cost of Community Care for Discharged State Hospital Patients: A 3-Year Follow-Up Study。The American Journal of Psychiatry,156,920-927。  new window
16.Weisbrod, B.A.(1981)。Benefit-cost analysis of a controlled experiment: treating the mentally ill。Journal of Human Resources,16(4),523-548。  new window
17.謝佳容、蕭淑貞(20060900)。臺灣社區精神復健機構的服務現況與展望。精神衛生護理雜誌,1(2),41-50。  延伸查詢new window
18.李靜玟、吳肖琪(20050800)。市場競爭及其他因素對精神科急性住院病患醫療利用之影響。臺灣公共衛生雜誌,24(4),296-305。new window  延伸查詢new window
19.楊惠娟、李卓倫(20070400)。醫院與衛生所承辦巡迴醫療的經濟評估。臺灣公共衛生雜誌,26(2),110-117。new window  延伸查詢new window
20.Rosenbaum, Paul R.、Rubin, Donald B.(1983)。The Central Role of the Propensity Score in Observational Studies for Causal Effects。Biometrika,70(1),41-55。  new window
21.文羽苹、許玫玲(20051200)。預防保健的成本效益評估:以乳癌篩檢為例。臺灣公共衛生雜誌,24(6),519-528。new window  延伸查詢new window
研究報告
1.王惠玄(2003)。社區復健中心成效及成本效益評估 (計畫編號:DOH92-TD-1029)。臺北市:衛生署。  延伸查詢new window
2.楊銘欽(2006)。衛生醫療業務成本及效益評估基本規範與實際案例研究 (計畫編號:95F1224)。台北:衛生福利部。  延伸查詢new window
學位論文
1.林麗瑞(2006)。慢性精障者醫療資源利用相關性研究(碩士論文)。靜宜大學。  延伸查詢new window
2.曾洙荔(2003)。慢性精神病患社區復健成效探討(碩士論文)。慈濟大學。  延伸查詢new window
3.陳巧珊(2009)。社區復健模式對精神分裂症患者再入院風險影響(碩士論文)。臺北醫學大學。  延伸查詢new window
圖書
1.Breakey, W. R.、郭峰志、胡海國(2001)。現代社區精神醫療:整合式心理衛生服務體系。臺北市:心理出版社。  延伸查詢new window
2.葉英堃、吳中立(1990)。臺北地區精神醫療網主要核心醫院門診治療的成本效益分析。臺北:行政院研究發展考核委員會。  延伸查詢new window
3.郭昱瑩(2007)。成本效益分析。台北:華泰文化。  延伸查詢new window
其他
1.Parsons, L.S.,Ovation Research Group。Performing a 1: N case-control match on propensity score,http://www2.sas.com/proceedings/sugi29/165-29.pdf., 2013/09/16。  new window
2.衛生福利部(2013)。衛生統計動向,http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312, 2013/09/16。  new window
 
 
 
 
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