從超長住院探討我國精神病床利用情形

The Study of the Utilization of Psychiatric Beds in Taiwan

去機構化且發展社區式照護為各國趨勢，然我國精神病床數仍逐年增加。本研究探討住院超長情形及精神病床利用之合理性。方法：以全民健保資料庫2006年申報精神科出院者為對象，住院日數分別以當次住院、併入出院後1日、30日內再住院計算，急性住院超長計算超過30、60或90日，慢性住院超長計算超過60、90、150或180日，來探討我國精神病床之利用。結果：以當次住院且超過90日估計急性床可減少645床；以超過60、90、150、180日定義，慢性床可節省3,500床以上；併入再住院日數計算超長住院，對急性住院影響較大。結論：我國每萬人口精神病床數較多數OECD國家高且逐年上升，且超長住院情形嚴重，政府應先加強管理90日急性與180日慢性超長，並重新分配精神醫療資源，不宜再以擴增精神病床為重點，應挹注資源於發展居家及社區式心理健康促進及精神醫療照護服務。

When most countries are working with deinstitutionalization to decrease their psychiatric beds, and develop their community mental health services, psychiatric beds in Taiwan are still increased in recent years. Therefore, it is worth to explore the reasonable utilization of psychiatric beds under different scenarios of overstay in Taiwan. Methods: The claim data of discharged psychiatric inpatients in 2006 was collected from the National Health Insurance (NHI) in this Historical cohort study. The length of stay (LOS) of readmission within 1 or 30 days were merged into the LOS of the last admission. The categories of overstay were divided into: 1) over 30, 60 or 90 acute hospital days, 2) over 60, 90, 150 or 180 chronic hospital days. These categories of overstay were used to calculate the difference of LOS between Taiwan and America, and to estimate the reasonable utilization of psychiatric beds in Taiwan. Results: If the overstay of acute inpatient beds could be avoided, It might reduce 645 acute psychiatric beds by using the definition of LOS over 90 days. It might reduce 3500 or above chronic psychiatric beds by using the definition of over 60, 90, 150, 180 chronic hospital days. The merged effect of LOS of readmission was bigger in acute inpatients and could be ignored in chronic inpatients. Conclusions: The number of psychiatric beds per 10 thousand populations in Taiwan was higher than most OECD countries and kept on increasing. The situation of overstay of psychiatric inpatients was severe in Taiwan. Facing rapid aging in Taiwan, government should re-allocate the mental health budget, shift more efforts to develop home and community mental health promotion and care services, and not to increasing psychiatric beds.