自閉症患者全民健康保險健保門診醫療利用分析

Trends in NHI Outpatient Visits and Expenditures among Persons with Autism in Taiwan

目的：本研究藉由分析全民健康保險門診申報資料，以了解自閉症患者就醫醫療利用之長期趨勢，研究結果期能提供醫療專業人員及衛生政策決定者在評估診斷與擬定政策之參考。方法：使用1997-2011 年全民健康保險資料庫，將門診處方及治療明細檔ICD-9 編碼主、次診斷編碼Acode 為213 或ICD-9-CM 為299.x之個案定義為本研究之樣本，分析門診醫療利用情形與變化趨勢。結果：使用健保之自閉症人數自1997 年的10,875 人呈逐年增加至2011 年的23,984 人，18 歲以下居多，男性人數高於女性。女性的平均年申報門診醫療費用高於男性。年門診次數與平均年申報門診醫療費有重大傷病註記或中低收入戶高於一般身分；2007 年之後6 歲以下高於其它年紀。學齡前與小學生復健科逐年遞增。結論：自閉症患者的整體的醫療耗用日漸增加，小學與學齡前患者醫療利用又遠高於其他年齡層，且復健利用自2007 年後遠高於其他科別。因此建議政府應當彙整醫療資源和衛生政策，提供整合性之醫療服務，以減少門診次數，降低照顧者經濟與其他方面之負擔。

This study was an examination of population-based data of outpatient visits and associated factors among persons with Autism. The study sample included all national health insurance beneficiaries with Autism, and their outpatient visit records from 1997 to 2011 were collected for the analyses. Furthermore, this study also analyzed data to examine the trends of outpatient visits and to determine the related influencing factors of those visits. The results revealed that persons with Autism had significantly more medical care visits than the general population in Taiwan, and age was the major factor contributing to their outpatient visits. Preschool children with Autism had the highest frequency of outpatient visits, and this frequency increased more than that of any other groups studied from 1997 to 2011. This group of children also used more outpatient rehabilitation services than their counterparts. This study indicates that the health authority should examine the medical care trends of persons with Autism, particularly children, to determine their medical care needs and quality of care.