精神疾病患者出院後門診追蹤與轉介精神復健機構治療之成本效益分析

研究目的　　精神疾病患者的社區復健自1985年推展至今，有關精神復健機構成本效益的研究付之闕如，因此，本研究希望針對精神疾病患者出院後門診追蹤與轉介精神復健機構治療之成本效益進行探討。研究方法　　本研究為評估研究，以國家衛生研究院「全民健康保險研究資料庫」為資料來源，採用2000年百萬歸人檔的資料，篩選出2004年1月1日至2008年12月31日期間曾於精神科住院之精神疾病患者，將於此期間首次出院後之病患納為研究樣本，分為門診追蹤治療組與精神復健治療組，並針對這兩組病患出院後2年期間之醫療資源使用情形，以卡方檢定、獨立樣本t檢定、二項對數迴歸分析等統計方法及成本效益評估指標(淨現值、益比本、內部報酬率)，進行成本效益分析。研究結果　　精神疾病患者共計11,609人次，進行歸戶後為4,763人，經整理後為4,373人，其中出院後接受精神科門診追蹤治療者共計4,044人，出院後轉介精神復健機構治療者共計329人。經傾向分數1:1配對後，兩組各取326人為醫療資源使用成本效益分析之研究樣本，經檢定後，兩組在人口學特質與臨床特徵均未達顯著性相關或差異。本研究是以健康保險支付者為觀點，成本採醫療直接成本，以申報點數加以計算分析。由成本效益評估指標結果發現，門診追蹤治療與精神復健治療均為值得投資之方案，其中又以門診追蹤治療的成本效益優於精神復健治療。本研究進一步以增量分析檢定，結果顯示精神復健治療方案屈居劣勢，最後經由敏感度分析顯示本研究之成本效益分析結果具穩定的可信度。結論與建議　　精神復健治療與門診追蹤治療相較，雖未有明顯的成本效益之優勢，但由精神科住院醫療費用統計資料發現，門診追蹤治療組不論在平均醫療費用或是總醫療費用部分，第二年均較第一年增加；而精神復健治療組則呈現相反情形，由於本研究僅追蹤2年期間醫療資源使用情形，無法進一步瞭解兩組的趨勢變化，建議日後拉長追蹤年數，以瞭解兩組成本效益之變化。本研究建議，政府單位應推廣、鼓勵增設精神復健機構，醫療機構應建構、規畫完善之個案管理制度，而醫療專業人員則應加強病患藥物遵從性，且視病患個別化需求，轉介適切之精神復健機構持續復健治療之。

關鍵字

精神疾病患者；精神復健機構；成本效益分析；傾向分數配對

並列摘要

Objective Since 1985, the community rehabilitation for the psychiatric patients is promoted. But there is no study on the cost-benefit analysis for the institutions of psychiatric rehabilitation till now. So this study will investigate the cost-benefit analysis of the psychiatric patients who discharged from hospitals, either following up at outpatient departments or transferring to institutions of psychiatric rehabilitation. Methods This study is an assessment study. The data is obtained from Normalized Million People File on 2000, National Health Insurance Research Database. We select the inpatient psychiatric patients who discharged on 2004.1.1 ~ 2008.12.31. The cases are divided to the group of outpatient follow-up and the group of psychiatric rehabilitation. We investigate the cost-benefit analysis for the medical resource utilizations within 2 year after discharge of these two groups, using chi-square t-test, independent t-test, binary logistic regression analysis, and the indicators of cost-benefit analysis(Net Present Value, Benefit-Cost Ratio, Internal Rate of Return). Results A total of 11,609 psychiatric patients are included. After normalizing, there is 4,373 cases in the study, 4,044 in the group of outpatient follow-up and 329 in the group of psychiatric rehabilitation. By using propensity score matching (PSM), we select 326 cases of each group for study. There is no significant difference in the demographic characteristics and clinical manifestations of these two groups. Our study is in the view of health insurance payers. The costs are direct and are analyzed by reporting points of NIH. From the indicators of cost-benefit analysis, we find that outpatient follow-up and psychiatric rehabilitation are both worth the investments. But the cost-benefit of the group of outpatient follow-up is better than that of psychiatric rehabilitation. By using Incremental Analysis, the program of psychiatric rehabilitation is disadvantaged. At last, the results of this study are stable and credible after Sensitivity Analysis. Conclusions and Suggestions Though there is no advantage in the cost-benefit of the group of psychiatric rehabilitation compared with the group of outpatient follow-up. Analyzing the data of the inpatient medical expenses in the group of outpatient follow-up, the average and total medical expenses in the second year is higher than the expenses in the first year. But the data in the group of psychiatric rehabilitation is converse. Due to following for 2 years only, we do not find out the trends of these two groups. Maybe prolong the years of following in the future study. We suggest the government should promote the institutions of psychiatric rehabilitation. Medical institutions should construct the system of case management. Medical professionals should encourage the medication adherence of patients and transfer the patients to the institutions of psychiatric rehabilitation for continuing rehabilitation treatment. Key words: psychiatric patients, institution of psychiatric rehabilitation, cost-benefit analysis, propensity score matching

並列關鍵字

psychiatric patients ； institution of psychiatric rehabilitation ； cost-benefit analysis ； propensity score matching

參考文獻

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精神疾病患者出院後門診追蹤與轉介精神復健機構治療之成本效益分析

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