台灣親密關係暴力被害人醫療利用與費用分析

Medical care utilization by intimate partner violence victims and associated costs in Taiwan

目標：本研究旨在探討台灣親密關係暴力被害人醫療服務利用與費用，並估算台灣親密關係暴力被害人的每人每年醫療費用。方法：本研究使用2015年家暴通報明細檔，以20-64歲14,531位親密關係暴力被害人為研究對象，串聯至全民健保資料庫分析個案的住院、門診與急診醫療利用情形，並比較其與一般就醫民眾（對照組）的醫療利用差異。結果：本研究發現，親密關係暴力被害人在案期間的住院、門診與急診就醫率及就醫次數都比對照組顯著較多。而在醫療費用上，親密關係暴力被害人在案期間的醫療費用亦顯著比對照組高。至於就醫原因，親密關係暴力被害人的住院與門診案件都以精神疾患較對照組來的多，急診案件則是因損傷及中毒而就醫的情形顯著較多。此外，親密關係暴力被害人平均每人每年醫療費用為56,202元，比對照組的23,117元多了33,085元，高約2.4倍。結論：醫療利用成本分析可作為政府發展親密關係暴力預防與醫療服務提供相關政策的有效工具。（台灣衛誌 2020；39(1)：52-63）

Objectives: To estimate medical care utilization by intimate partner violence (IPV) victims and the associated costs in Taiwan. Methods: A Ministry of Health and Welfare domestic violence reporting data set containing data of 14,531 IPV victims aged 20–64 years was linked to utilization and cost data from the National Health Insurance (NHI). The NHI data included utilization and costs of medical services, such as impatient, outpatient, and ambulatory care. A comparative analysis of the utilization and costs between IPV victims and non-IPV patients was performed. Results: Compared with non-IPV patients, IPV victims demonstrated higher medical service utilization and associated costs. Moreover, they were considerably more likely to have mental health disorders in inpatient and outpatient settings and have injuries in ambulatory care settings. For IPV victims, the average cost of medical services was NT$56,202 per person per year—approximately 2.4 times higher than that for non-IPV patients. Conclusions: Cost analysis is a tool useful for estimating medical care utilization and associated costs, the results of which can facilitate the formulation of government policies for both IPV prevention and medical service provision. (Taiwan J Public Health. 2020;39(1):52-63)