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

A cost-benefit analysis of psychiatric patients after discharge from hospitals and followed-up as outpatients or transferred to institutions for psychiatric rehabilitation

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.