台灣老年精神住院病患住院天數與直接醫療成本之分析

Length of Stay and Direct Medical Costs for Psychogeriatric Inpatients in Taiwan

目的：本文分析老年精神住院病患的住院天數(LOS) 與直接醫療成本(DMC)。方法： 資料來自於健保資料庫精神疾病住院病患歸人檔。各精神疾病的LOS 及DMC，以T、卡方 檢定及Tobit 迴歸進行分析。結果：平均LOS 為43.53 天，平均DMC 為2,576 美元。癡呆 症是最常見的診斷。平均LOS 和DMC，男性顯著高於女性，非藥費成本佔全部成本的九 成。情感性精神症的LOS 男性顯著的高於女性。病患的LOS 及DMC 在性別、各疾病別間 及三個醫院層級內都有不同程度的差異。另，癡呆症及妄想症的LOS、重鬱症的DMC 有跨 醫院層級的異質性。迴歸分析結果顯示，精神分裂症的LOS 及DMC 顯著地高於癡呆症；在 社區醫院的LOS 顯著高於綜合醫院，而DMC 則相反；相較於公立醫院，私立醫院的藥費成 本較高，而 LOS 及非藥費成本較低。結論：影響LOS 及DMC 的差異原因主要來自於性別、 疾病別及醫院層級別。藥費和非藥費分別佔DMC 的一成及九成，而性別只有對非藥費有顯 著差異。

Objective: In this study, we aimed to analyze the length of stay (LOS) and direct medical costs (DMC) for psychogeriatric inpatients in Taiwan. Methods: We obtained the data from the Psychiatric Inpatient Medical Claim database of Taiwan’s National Health Insurance. LOS and DMC of different mental illnesses were analyzed. Results: The average LOS of our study patients was 43.53 days, and the mean DMC was 2,576 US dollars. Dementia was the most common psychiatric diagnosis. Average LOS and DMC were signifi cantly higher in male patients than female (p < 0.001 and p = 0.022, respectively). Over 90% of DMC were non-drug expenses (NDE). The LOS of patients with dementia and major depression was signifi cantly higher for males than for females (p < 0.001). Patients’ LOS and DMC showed differences among gender, diagnosis, and type of hospital. The LOS of dementia and delusional disorders and the DMC of major depressive disorders had heterogeneities across hospital types. The results of regression analysis indicated the LOS and the DMC of schizophrenic patients were signifi cantly higher than those of dementia patients (p < 0.001); the LOS of community hospitals was signifi cantly higher (p < 0.001) than that of general hospitals (medical centers and regional hospitals), with the opposite being true for DMC. Compared to public hospitals, the drug expense (DE) was signifi cantly higher in private hospitals (p < 0.04), but LOS and NDE were lower. Conclusion: The determinants affecting differences of LOS and DMC of psychogeriatric inpatients were gender, psychiatric diagnosis, and type of hospital. The DE and NDE of DMC were about 10% and 90%, respectively, but only the NDE showed signifi cant difference based on gender.