- 學位論文
EXPLORING MEDICAL UTILIZATION BY PATIENTS WITH AUTISM IN TAIWAN
EXPLORING MEDICAL UTILIZATION BY PATIENTS WITH AUTISM IN TAIWAN
並列摘要
BACKGROUND: Autism is a complex developmental disability that typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills. The growing prevalence and incidence rate reported for autism spectrum disorders increases medical health care costs in many countries, and has become a global concern regarding health care service provision. In terms of policy decisions, it must be acknowledged that the families of autism patients have unmet service needs and are often forced to finance much of this care out of pocket. This present study aims to identify medical utilization by patients with autism in Taiwan and compare medical utilization between patients with and without autism in the 7-12 group age in 2007 and follow up to 2009. METHODS: The study used data from the Taiwan National Health Research Institute (NHRI), from 2007 and a follow-up in 2009. Target populations were selected, with 176 cases of autistic disorders and 880 non-autism cases in the 7-12 age group, for a ratio of 1:5. Statistical analysis was carried out using SAS version 9.2 to analyze the data. RESULTS: This study found that patients with autism were significantly more likely to utilize both ambulatory care and hospitalization. Those of younger age were less likely to utilize ambulatory care (p<.0001). For the number of hospitalizations, males were significantly less likely to be hospitalized compared to females (p<.008). In term of expenditure on ambulatory visits, patients with autism were more likely incur greater expenditure on these services with a strongly significant (p<.0001). Also, adjusting for age – younger ages of autism are likely to spend less on ambulatory visits. For expenditure on hospitalizations, age was significant, which means those of younger age with autism are likely spend more on these services. With regard to different geographical areas, Central Taiwan shows a particularly strong tendency to spend less on hospitalizations (p<.002). Lastly, comparing medical utilization, autistic patients were much more like to use ambulatory care services, with a remarkable mean (56.35 ± 38.64), than non-autistic patients (26.01±20.60), which is related to the higher mean for expenditure on ambulatory care for patients with autism (65873.90 ± 62887.43) compared to those without autism (13401.26±11329.58). CONCLUSION: The present study confirms that patients with autism had higher utilization of ambulatory care and also that there are many factors associated with autism patients, who are more likely to use the medical utilization by related to its greater cost. As medical utilizations and cost are still the main issue for both families with autism and the country, then, from the macro view, policy makers would need to pay more attention on the findings from such an inquiry. The data provide a guide to the principal implications to consider when devising appropriate prevention and intervention approaches that take these children’s unique needs into account.