嚴重精神病患經濟成本分析

The Economic Cost of the Severely Mentally Ill Patients

本研究欲以社會的觀點（societal perspective），估算嚴重精神病患之經濟成本，以供制定精神衛生政策的參考。主要研究方法係以郵寄問卷的方式收集三個康復之友協會精神病患經濟成本的相關資料；無法由問卷取得的資料則經由次級資料的收集而提供。並以疾病盛行狀況為基礎的計算方法（prevalence based approach），估算出嚴重精神病患一年之平均經濟成本。研究結果顯示每位嚴重精神病患在1994年一年之平均經濟成本為633,569元，精神分裂症病為680,889元，情感性精神病病患為412,738元。每位嚴重精神病患平均一個月之經濟成本為5萬元左右。其中直接成本佔8.8%，間接成本佔78.3 %。如果以1989年台灣地區精神疾病流行病學研究資料之精神分裂症一年盛行率0.24%，情感性精神病為0.6%來估算，則全台灣地區精神分裂症患者在1994年一年耗費之經濟成本約180億元，情感性精神病病患為450億元。基於間接經濟成本佔總經濟成本的比例甚高，建議衛生、福利主管機關在精神病患的治療外，亦應研擬方案以增加精神病患獨立自主能力，以減少照顧者甚至病患生產力之損失，進而降低整個社會對嚴重精神病患負擔之經濟成本。

In the present study, the economic cost of severely mentally ill patients was explored from a societal perspective. To serve this purpose, all members of three Associations of the Kun-Fu Friends were contacted via mailed questionnaires regarding economically related data. The cost of insurance reimbursements and government subsidies were not discernible from the questionnaire, hence, they were estimated from secondary data. Based on such data, the average annual economic cost was then estimated by the ''prevalence based approach.'' The results revealed that in 1994, the average annual economic cost of each severely mentally ill patient was NT$633,569, which amounted to approximately NT$50,000 each month. The annual cost for patients with schizophrenic and/or affective disorder was NT$680,889 and NT$412,738 respectively. Among the total cost, 18.8% was direct cost while 78.3% was indirect cost. In further analysis based on previous epidemiological data, patients with schizophrenic and/or affective disorder in Taiwan would respectively have a combined cost of approximately 18 billion and 45 billion NT dollars in a single year. Considering the high indirect cost caused by the severely mentally ill patients, the authors suggest that in addition to providing direct medical services, psychiatric service policies should focus on enhancing the mental patients' capability for independent living in society. Hence, productivity of both patients and care-givers is expected to be maximized.