「精神分裂症個案管理計畫」之門診病患就醫行為與費用探討-以某區域教學醫院為例

Healthcare Seeking Behavior and Cost of Outpatient in Schizophrenia Case Management Plan: An Example of a Regional Teaching Hospital

張瓊媖(Chiung-Ying Chang)

指導教授 ： 詹前隆

元智大學/資訊學院/資訊管理學系/碩士(2012年)

https://doi.org/10.6838/YZU.2012.00099

摘要

本論文研製在探討自2010年推出之「精神分裂症個案管理計畫」之門診病患就醫行為與費用探.討。研究方法以SPSS 12.0統計軟體進行統計檢定：（1）個案管理計畫實施前後以Pair-T檢測發現588個案，實施個案管理計畫後比較在門診精神科每人次醫療費用、門診精神科就醫次數、住院精神科每人次醫療費用、住院精神科住院天數均呈現下降趨勢，並無顯著差異；實施個案管理計畫後比較在門診精神科診療費、住院精神科就醫次數，呈現顯著差異；（2）後測-參與與否『精神分裂症個案管理計畫』，統計無顯著差異，但較非參與個案管理計畫門診每人次醫療費用、每人次藥費、每人次診療費獲得有效控制成長；（3）家人支持度行為對實施個案管理計畫後門診精神科醫療費用與藥費，具顯著性差異。針對「精神分裂症個案管理計畫」支付制度實施初期而言，其門診精神科(醫療費用、藥費、就醫次數)、住院精神科(醫療費用、藥費、住院天數)耗用是有比過去減少，顯示醫療效率是有提升的。在整體支付點數上，家人支持度行為醫療費用集中於主動積極協助病人就醫及無親屬或幾乎拒絶任何形式之合作支持兩端，對病患來說，在相同之疾病下，個案管理計畫實施多方關注病患本身，使得病患重視疾病認知，減少住院就醫次數，可見對病患亦是有利。

關鍵字

精神分裂症 ； 個案管理計畫 ； 醫療費用 ； 藥費

並列摘要

This thesis is developed to investigate the 2010 launch of the " Healthcare Seeking Behavior and Cost of Outpatient in Schizophrenia Case Management Plan: An Example of a Regional Teaching Hospital". Statistical analyses were performed using SPSS 12.0 of the statistical software. (1) By using the pair-t test to compare the case management plan before and after the 588-case result, it showed that per person psychiatric outpatient expenditure, psychiatric outpatient medical visits, the per person psychiatric inpatient expenditure, and inpatient psychiatric hospital days were in a downward trend and no significant differences. But the outpatient psychiatric clinic fee and the number of inpatient psychiatric medical treatment were significantly different. (2) the post-test to participate or not Schizophrenia case management plan had no significant statistical difference compared with non-participation in case management plan outpatient per person medical costs per person medical expenses per person medical fees for the effective control has grown up (3) the family support’s behavior on the implementation of psychiatric case management plan were significantly different at psychiatric outpatient expenditure and medical fee. So, the psychiatric outpatient parts (medical cost, medical fee, and medical visits) and the psychiatric inpatient parts (medical cost, medical fee and hospital days) were reduced than past. This is useful to increase the medical efficiency at the payment system’s early stage in implementing the schizophrenia case management plan. Besides, on the points of the overall payment, family-support behavioral for medical cost were belong to helping patients actively and no family helping, or almost rejected any type cooperation. Therefore, it was helpful for patients to focus on disease awareness, reduce hospitalization and medical visits when implementing the case management plan.

並列關鍵字

Schizophrenia ； Case management plan ； Medical cost ； Medical fee

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