台灣住院老年精神病人醫療利用之趨勢研究：2002-2006

Trends in Healthcare Utilization by Psychogeriatric Inpatients in Taiwan: 2002-2006

目的：本研究目的在測量台灣65歲以上老年精神病人的精神醫療服務利用情形及其住院天數和直接醫療成本的決定因素。另外，本研究也評估從西元2002年到2006年主要老年精神疾病的住院天數及直接醫療成本等醫療利用的趨勢。方法：本研究的次級資料庫是來自於台灣國家衛生研究院（NHI）之全民健保資料庫。詳細的資料從精神疾病住院病患歸人檔（PIMCI）分析而來。本研究樣本包括12,547位從西元2002年1月1日到2006年12月31日的老年精神住院病人。資料分析有描述性統計、單因子變異數分析、t-檢定及零截斷Tobit迴歸分析。結果：自西元2002年到2006年間有12,547位老年精神住院病人為樣本，佔資料庫總人數的13％。男性佔62.90％，前五大主要診斷為失智症（34.36％）、情感性疾病（21.65％）、思覺失調症（9.22％）、器質性精神症（7.23％）以及妄想症（4.37％）。大部分病人住在綜合醫院（63.94％）。女性病人的平均住院天數及直接醫療成本分別是42.70天及美金2,680元，男性病人則分別是56.50天及美金3,011元。相較於其他疾病，思覺失調症病人有最長的平均住院天數（71.35天）及最高的平均直接醫療成本（3,642元）。在西元2002年到2006年期間，平均住院天數及直接醫療成本呈現向上傾向。平均住院天數及直接醫療成本，男性病人總是高於女性病人。三種主要疾病：失智症、思覺失調症及情感性疾病都呈現類似型態的性別差異，除了2005年的思覺失調症。結論：自西元2002年到2006年間，台灣老年精神住院病人的平均住院天數及直接醫療成本有逐年增加的趨勢。老年精神住院病人住院天數及直接醫療成本的決定因素是男性、思覺失調症及在公立醫院住院。

Purposes: The aims of this study were to determine trends in the utilization of psychiatric services and the determinants of length of hospital stay (LOS) and direct medical costs (DMC) by the elderly (aged 65 and over) in Taiwan from 2002 to 2006. Methods: The secondary data used in this study were obtained from the National Health Insurance Research Database of Taiwan’s National Health Insurance program. Detailed data were extracted from the Psychiatric Inpatient Medical Claim (PIMC) subset. The study sample included 12,547 psychogeriatric inpatients who had been admitted to and discharged from psychiatric wards of hospitals from Jan 1, 2002, to Dec 31, 2006. The PIMC dataset contained all the claims data of patients from 1996 to 2007. Data were analyzed by descriptive statistics, one-way ANOVA or t-tests, and a zero truncated Tobit regression. Results: The sample of 12,547 psychogeriatric inpatients accounted for 13% of all the psychiatric inpatients in this dataset. The proportion of male patients was 62.90%, and the five major diagnoses were dementia (34.36%), affective disorders (21.65%), schizophrenia (9.22%), organic mental disorders (7.23%), and delusional disorders (4.37%). Most patients were hospitalized in general hospitals (63.94%). The average LOS and DMC were 42.70 days and 2,680 USD, respectively, for female patients and 56.50 days and 3,011 USD, respectively, for male patients. Patients with schizophrenia had the longest mean LOS (71.35 days) and highest DMC (3,642 USD) of all those with mental disorders. The trends in LOS and DMC exhibited an upward tendency between 2002 and 2006, and the LOS and DMC of male patients were always higher than those of female patients. Three major mental disorders--dementia, schizophrenia, and affective disorders--all presented a similar increasing pattern with gender differences, with an exception being schizophrenia in 2005. Conclusions: From 2002 through 2006, the trends in mean LOS and DMC of psychogeriatric inpatients increased annually in Taiwan. The primary determinants of LOS and DMC of psychogeriatric inpatients were male gender, a diagnosis of schizophrenia, and being cared for in public hospitals.