台灣非愛滋替代治療藥癮者全民健康保險資源使用情形探討

Medical care utilization under National Health Insurance by people with heroin addiction enrolled in a methadone substitution treatment program

目標：我國於2009年起對非愛滋病之藥癮者提供治療補助，本研究以回溯性世代研究法，探討穩定使用美沙冬替代治療與否，對於藥癮者健保使用之影響。方法：以2009至2014年間之美沙冬替代治療藥癮者作為研究樣本，以傾向分數加權後使用加權複迴歸分析美沙冬替代治療之穩定組與中斷組間健保資源使用情形之差異。結果：在門急診點數對數值之加權複迴歸檢定結果顯示，在控制性別、年齡、收入、就醫場所層級別、權屬別、地區別後，穩定組年平均門急診點數對數值比中斷組增加9%（p=0.0023）；在門急診就醫次數部分之卜瓦松複迴歸分析結果顯示，控制前述變項後，穩定組年平均門急診次數較中斷組增加14%（p＜0.001）。結論：穩定組之健保門急診之年平均次數、年平均點數對數值都顯著高於中斷組，惟傾向權重配分後之中斷組年平均住院點數多於穩定組，雖未達統計上顯著差異，仍可後續研究探討其原因。 Objectives: Since 2009, the Taiwanese government has subsidized treatment for non-AIDS-related drug addiction. The aim of this retrospective cohort study was to investigate the effect on National Health Insurance (NHI) resources of treatment for people with addiction who enrolled in a methadone substitution treatment program. Methods: Data from 2009 to 2014 of people with drug addiction who were treated with methadone were collected as samples. Analytical tools such as the Inverse Probability of Treatment Weighting (IPTW), which is based on propensity score and weighted multiple regression, were used to further compare the use of NHI resources by the stable-treatment and interrupted-treatment groups. Individual characteristics of sex, age, and income level were controlled for in addition to the level, ownership, and Bureau of NHI branch of the medical institution. Results: According to the weighted multiple regression analysis results of the NHI point values of the outpatient and emergency departments, the NHI point values of the stable-treatment group increased by 9% relative to the interrupted-treatment group (p = 0.0023). The results of a Poisson regression on the NHI utilization frequency of outpatient and emergency department visits indicated that with the same control variables, the average NHI utilization frequency of the stable-treatment group increased by 14% relative to the interrupted-treatment group (p ＜ 0.001). Conclusions: Among people with addiction who enrolled in the methadone substitution treatment program, those in the stable-treatment group had not only higher logarithmic NHI point values but also higher NHI utilization frequency in their outpatient and emergency department visits compared with the interrupted-treatment group. Although no statistical significance was observed, further research should investigate why, after IPTW, the average annual inpatient point values for the interrupted-treatment group were higher than those for their stable-treatment counterparts.