精神分裂症 ; 求醫行為 ; 醫療利用

schizophrenia ; help-seeking behavior ; medical utilization

彭彥慈(Yen-Tzu Peng)

指導教授 ： 葉玲玲

亞洲大學/健康學院/健康管理研究所/碩士(2006年)

摘要

本研究目的為探討精神分裂症患者之求醫行為與影響因素，並探討求醫行為對醫療利用之影響，藉此瞭解精神分裂症患者的求醫行為，以作為將來針對精神分裂症患者之支付制度的參考。
研究對象為國家衛生研究院全民健保資料庫抽樣歸人檔之2000年就醫之精神分裂症患者，排除未滿18歲及2000年前已住院的個案，研究資料為620位精神分裂症患者2000年至2004年所有就醫資料。本研究參考Andersen所提出的健康服務利用模型（behavior model of health services use），探討精神分裂症患者的傾向因素、能用因素、需要因素、以及就醫機構特性對求醫行為的影響，並分析精神分裂症患者的求醫行為對醫療利用的影響。
研究結果發現精神分裂症患者約有三成有固定就醫醫師，約七成的患者有固定就醫機構，約五成的患者沒有跨區就醫，且有八成以上的患者就醫科別為精神科。年齡、投保類別、就醫機構特性對求醫行為均有影響。
患者與精神分裂症有關的門診、急診、住院之使用比率逐年下降，但各年度服務使用次數變化不大；門診與住院費用則呈現逐年上漲。門診使用比率從92％逐年下降至68％，平均使用次數約11-13次。住院使用比率從第一年14％下降至第四年9％左右，每年平均住院次數變動不大約1.5次。社會心理治療的各項使用比率約從7.1％至18.7％左右。社會心理治療的各項治療次數約2.5至20.4次。社區復健使用比率為7.4％至10.3％左右。研究對象各項治療項目每年費用呈現逐年增加的結果，尤以第四年上漲最多。研究對象與精神分裂症無關之各項醫療利用的使用比率與使用次數每年變化不大。
研究結果發現各種求醫行為對醫療利用與費用均有影響。沒有因為精神疾病就醫的患者使用較高與精神分裂症無關之門診次數與門診費用。固定就醫機構者與精神分裂症有關的門診、住院及職能治療次數較低。就醫科別為精神科的患者其行為治療次數較低。
研究發現精神分裂症患者之求醫行為有別於一般民眾，且對於醫療利用與費用亦有重要影響。整體而言，精神分裂症患者傾向有良好的求醫行為，此結果對於未來實施精神分裂症患者之論質計酬有所助益。主管機關應鼓勵患者有正向的求醫行為，以便確保患者擁有完善的治療及復健照護與疾病照護品質。

關鍵字

精神分裂症 ； 求醫行為 ； 醫療利用

並列摘要

Abstract
The objective of the present research is to investigate the factors related to help-seeking behaviors in the patients with schizophrenia. Additionally, we try to treat of the help-seeking behavior effects the medical utilizations. We expect the results from the analysis of help-seeking behaviors of patient with schizophrenia could be the reference material for the design of payment system.
Samples of the patients with schizophrenia in our investigation were adopted from the National Health Insurance registry for beneficiaries claims data files in 2000 which charged with National Health Research institution. The cases that were under 18-year-old and who have been the hospitalized patients before 2000 were excluded from the analysis. Medical information came from 620 patients with schizophrenia during 2000 and 2004 were involved, finally. Based on Andersen’s “behavior model of health services use model”, through three dimensions, predisposing, reinforcing, enabling factors, and the characteristics of the healthcare organizations, we tried to examine the related factors to the help-seeking behaviors of patient with schizophrenia, and tried to analyze how the medical utilizations influenced by schizophrenic patients’ help-seeking behaviors, at the same time.
We found that there were 30%, nearly, of the patient with schizophrenia who went to seek the same doctor. There were around 70% of the patient with schizophrenia who went to the same healthcare organization, around 50% of the patient with schizophrenia who were not the cross-region visiting, and more than 80% of the patients who tried to seek the psychiatric services. Age, insured category and characteristics of the healthcare organization affected the help-seeking behaviors of patients with schizophrenia.
The utilization rates of the patients related with the outpatient services, emergency treatment, and the hospitalization in schizophrenia were decreasing year by year, but there wasn’t much difference between the frequencies of each year, besides, the expenditures on outpatient services and hospitalization were increasing during the observed years. The outpatient utilization rates decreased from 92%to 68%, and the average frequency was 11-13 times. The hospitalized utilization rates were decreasing from 14% in 2000 to 9% in 2004, and the average frequency was 1.5 times in each year. The utilization rates in various psychosocial therapies were rising generally from 7.1% to 18.7%, and the utilization in psychotherapy was ranged 14% to 18.7%, which was prominently higher those in the others. The frequencies between the psychosocial therapies were less consistent; those were raged around 2.5 to 20.4 times. The utilization rate in community rehabilitation, by the way, was about 7.4% to 10.3%. Whether any expenditure in treatment items among the subjects were increasing, especially in the forth observed year. Furthermore, there wasn’t much variation in the subjects’ utilization rates and frequencies that irrelevant to schizophrenia during the observed period.
According to the results in our analysis, not only the medical utilization but also the expenditure was effected by the help-seeking behaviors. The patients sought medical services without cause of schizophrenia had higher outpatient frequencies and expenditures on the services which weren’t in connection with schizophrenia. Patient with schizophrenia who went to the same healthcare organization had lower outpatient, hospitalized and vocational therapy frequencies. Patients who sought psychiatric had lower behavioral therapy frequencies.
In our investigation, the help-seeking behaviors of patients with schizophrenia were different from those of the common populations, and which also contributed the important influence upon medical utilizations and expenditures. Overall, patients with schizophrenia tend to have positive help-seeking behaviors; such phenomenon will be helpful for the implement of pay for quality payment system to the patient with schizophrenia in the future. The healthcare administrations should encourage patients to have positive help-seeking behaviors, in order to ensure that patients could receive the treatment, rehabilitation that will be more integrated and better with highly healthcare qualities.

並列關鍵字

schizophrenia ； help-seeking behavior ； medical utilization

參考文獻

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