臺灣慢性精神病發生、死亡、醫療利用分析

現代人由於社會及環境壓力，慢性精神病的盛行率有升高的趨勢，而且常因生活而忽略這類型疾病對我們的影響，包括危害個人身心健康、甚至是社會安全。臺灣罹患慢性精神病人數相當多，截至108年國人約有近20萬人持有慢性精神病重大傷病卡，佔所有重大傷病卡的21%，在重大傷病中僅次於癌症（來源：衛生福利部健保署）。慢性精神病中最多為「思覺失調症」（俗稱精神分裂症），卡數超過10萬張，第二名為「情感性精神疾病」（俗稱躁鬱症），是所有精神疾病中遺傳相關性最高，近年廣受關注的「老年期及初老年期器質性精神病態」（俗稱失智症）排名第三，預計隨著國人壽命延長而逐年增加。由於不少國人對於精神病存有誤解，國內對慢性精神病之研究也較少，精神病患之醫療與需求仍不夠清楚，因此本文以探究我國慢性精神病現況，以及患者的醫療利用及地區特性為目標，希冀研究成果可提供政府與各界之參考。本研究以重大傷病中之慢性精神病作為研究對象，探討慢性精神病之患者特性與醫療需求，透過發生、死亡、醫療利用之計算，分析慢性精神病重大傷病於時間、空間的趨勢與特性。本文使用之重大傷病資料庫來自於全民健保，資料年份為2003年至2013年，資料內容包括重大傷病證明明細檔(HV)、門診處方及治療明細檔(CD)、住院醫療費用清單明細檔(DD)、醫事機構基本資料檔(HSOB)等。分析發現慢性精神病發生率逐年下降，死亡率則呈現波動向下之趨勢，與癌症、整體重大傷病之發生率、死亡率趨勢有明顯差別。慢性精神病者的住院天數高於整體重大傷病者的平均，且為癌症患者的四倍。研究也發現10歲以下幼兒慢性精神病患者有較高醫療利用， 20歲左右有較高的住院需求，甚至超過癌症和整體重大傷病。

關鍵字

慢性精神病；全民健康保險；死亡率；醫療利用；空間分析

並列摘要

Mental illness becomes very common in modern world and many believe that the pressure in workplace and technological advance in social media are making us ill. People often neglect the impacts of mental conditions, including harm to personal physical and mental health, and even national security. Mental illness is the second leading catastrophic illness (CI) in Taiwan, accounting for 21% of all CI patients. Schizophrenia is the most common mental disease in CI, about 0.1 million patients, following by bipolar disorder and dementia. However, there were only a few researches on mental illness in Taiwan and the medical utilization of mental patients remains unknown. Thus, we aimed to explore the medical utilization of mental patients and if the number of mental patients will grow in this study. There is no consensus on the definition of mental illness and we adapted that of CI in this study. We used experienced data from Taiwan’s National Health Insurance to estimate the incidence rates, mortality rates, and medical utilization of mental patients. The analysis results showed that the incidence rates and mortality rate of mental disease decrease with time, indicating there will be fewer mental patients. The average inpatient days of mental patients were significantly higher than those of other CI patients, e.g., four times higher than those of cancer patients. However, because the mortality rates of CI mental patients are among the lowest in CI patients, the overall medical utilization of CI mental patients is not necessary to be the smallest in CI patients (e.g., ages 10 and below).