精神科門診與其他科別門診醫療利用比較之探討

研究目的精神疾病所產生的醫療照護成本，除對全民健康保險財務造成負擔之外，其間接成本亦對社會及家庭照護者造成沉重的負荷。我们希望藉由此研究結果，來瞭解精神科病患醫療利用情況與其他科別之比較，以避免精神科醫療費用被低估。 1.比較人口學特徵(性別、年齡)在選定科別之門診醫療利用之差異。 2.比較精神科門診與其他選定科別門診就醫次數之差異。 3.比較精神科門診與其他選定科別門診醫療費用之差異。 4.比較精神科門診與其他選定科門診高診次利用之差異。 5.探討人口學特徵與門診就診科別對就醫次數與醫療費用之影響。研究方法本研究係以「全民健康保險學術研究資料庫」之門診抽樣百萬歸人檔為研究資料，對民國95年至99年間之5年資料累加彙總，包括精神科、內科、洗腎科、牙科、家醫科、中醫科、耳鼻喉科、外科、急診醫學科、眼科、復健科、神經科、骨科、婦產科、泌尿科、放射線科、小兒科、皮膚科、神精外科、整型外科、結核科、病理科、核醫科、麻醉科、職業醫學科等25個科別，共包含63,823,095筆資料，使用工具SPSS for Windows 19.0版套裝軟體，以描述性統計及推論性統計進行資料整理與分析。研究結果女性於門診醫療之使用次數雖高於男性，但是在醫療費用上是男性高於女性。且年齡越高醫療費用之使用相對越高。精神科門診之平均醫療費用僅低於洗腎科，其平均醫療費用排序為洗腎科（46,607.96元）、精神科（1,724.60元）、內科（1,280.25元）、牙科（1,143.21元）、中醫科（546.12元）、家醫科（472.48元）、耳鼻喉科（426.22元）。依平均每人每年就醫次數的科別排序，精神科門診亦是在前5名之內，依序是洗腎科(34次)，內科(19次)，精神科(16次)，家醫科(14次)，中醫科(13次)。男性比女性平均多使用門診醫療費用約61元，每增加1歲則多增加使用門診醫療費用約2.7元。結論與建議政府應積極推動預防及關懷性計畫，如目前衛生局辦理的自殺防治及社區關懷計畫。再者，建議對於就醫次數異常之患者，應轉介至精神科門診來做評估，篩選其中之精神科病人，給予適當之治療以避免醫療資源的浪費。

關鍵字

門診醫療利用；高診次；精神科門診

並列摘要

Purpose The medical care cost of psychiatric illnesses is not only a financial burden for the National Health Insurance, it is also a indirect burden to the society and family care givers. We hope to understand the medical care use condition of patients in the psychiatric department compared to other departments to avoid the psychiatric department fares being underestimated. 1.Compare the differences in the demographic characteristic (sex, age) in the medical use of chosen outpatient departments. 2. Compare the differences in the number of medical use of chosen outpatient departments. 3. Compare the differences in the medical cost of chosen outpatient departments. 4. Compare the differences in the high medical use of chosen outpatient departments. 5.Investigate the effect of demographic characteristics and outpatient department use on the number of visits and the cost of medical use. Methods This study used the five year sampling of "National Health Insurance Academic Research Database" from 2006 to 2010, including a total of 63,823,095 sets of data, using SPSS for Windows 19.0 software package to sort and analyze data. Results Female had a higher number of medical visits than male, however, male had a higher medical cost use than females. Additionally, those older in age, their medical cost is higher. The average psychiatric medical cost is only lower than the dialysis department. The ranking of medical cost is dialysis, psychiatric, internal medicine, dentistry, traditional Chinese medicine, and otolaryngological department. From the average use of number of visits per person per year, the psychiatric department is also ranked in the top five. Conclusion and Suggestion The government is actively promoting prevention and care programs, for instance, the suicide prevention and community care programs promoted by the national health bureau. Furthermore, those with abnormal number of medical visits should be referred to the psychiatric department for assessment to screen out psychiatric patients, providing them with adequate treatment to prevent the waste of medical resources.