本研究旨在探討臺灣精神醫療資源與精神疾病跨區住院比例的變遷,並分析跨區住院比例的影響因素,藉以做為精神醫療相關政策的參考。本研究採用全民健康保險學術研究資料庫的承保抽樣歸人檔,以醫療網及精神醫療網兩個地理區域為分析單位,利用精神患者急性、慢性跨區住院比例作為精神醫療利用可近性的指標。並針對(1)台灣精神醫療資源配置情況、(2)精神醫療網政策目標之達成,及(3)急、慢性精神跨區住院比例的影響因素等進行分析。 研究結果顯示: (1)臺灣精神醫療資源分佈:提供精神住院的醫療機構由87家成長至108家,每萬人急性精神病床數也從1.72床明顯增加至2.24床,而慢性精神病床數也由3.32床大幅增加為4.35床。目前雖未達到醫療網計畫的目標數,但在數量上都已明顯增加,且在各區域間的分佈也有明顯改善。其中,區域級以上醫院的設置精神科及提供相關服務對精神病床的分佈具有顯著的重要性。 (2)精神醫療網政策的目標達成:在急性精神住院跨區比例方面,醫療區的跨區比例由32.3%增加為37.9%,未見明顯改善。但各區域間跨區比例的變異減少了18%,顯示醫療區間跨區住院的差異減少了。就慢性精神住院跨區比例而言,精神醫療網的跨區比例並無明顯改善(14.4%小幅增加為14.5%),但各區域間跨區比例的變異也減少了19.1%,顯示精神醫療網各地區間跨區住院的差異減少了。 (3)急、慢性跨區住院比例主要影響因素:在急性跨區住院比例影響因素方面,「急性精神病床數」在1997年有顯著的影響力,但到了2001年時醫療資源的影響力有明顯下降,顯示急性精神病床的供給有部分滿足了民眾的需求;在慢性跨區住院比例影響因素方面,1997年時「急性精神病床數」為明顯的影響因素,顯示慢性患者佔用急性精神病床的情形十分嚴重,到了2001年時變成「慢性精神病床數」為重要的影響因素,顯示資源的供給有明顯成效。 根據以上結果,本研究建議應持續鼓勵民間設立精神醫療機構,並平衡區域間資源的發展,以進一步增進精神醫療的可近性。
The scope of this study covers the medical resources of mental disease and the change of proportion in the mental disease cross-region admission in Taiwan. We also analyzed factors influencing the proportion of cross-region admission. The objective is to provide information and suggestions for government and private institutions working in the mental disease area to formulate their policies. We based our study on samples taken from the files of insured person in the database of the National Health Research Institutes. We treat the medical network and the psychiatric care network as two separate geographical regions as our unit of analysis. We use the proportion of cross-region admission of acute and chronic psychiatric patients as the index of the accessibility of the medical care for the mentally ill. We focused our analysis on the following: (1)The allocation of the medical resources for psychiatric care in Taiwan (2)The attainability of objectives of the medical policy of the psychiatric care networks (3)Factors influencing the proportion of cross-region admission between the acute and chronic psychiatric patients Following are our conclusion in each of the three areas we studied: (1)The allocation of medical resources for psychiatric patients in Taiwan The number of medical institutions providing in-patient services has increased from 87 to 108. The ratio of beds for the acute psychiatric patients per 10,000 has increased from 1.72 to 2.24, and that for the chronic psychiatric patients has increased from 3.32 to 4.35. Both are encouraging signs. Although these numbers have not reached the objective of the Plan of the psychiatric care network, they are no small improvement in themselves. The allocation of these services across Taiwan also has shown a noticeable improvement. Among these, the regional hospitals providing Psychiatric Ward and associated services are the major factors influencing the allocation of beds for the mentally afflicted person. (2)The achievement of the objectives of policy on the psychiatric care network The proportion of cross-region admission of the acute psychiatric patients has increased from 32.3% to 37.9% and shows no improvement at all. However, the variation of the proportion of cross-region admission has decreased 18%, which means the difference of the cross-region admission has decreased. For the chronic psychiatric patients, the variation of the cross-region admission of the psychiatric care network also did not show any improvement (from 14.4% to 14.5%);. The variation of the proportion on cross-region admission has also decreased 19.1%, which again means the difference of the cross-region admission among the local psychiatric care networks has decreased. (3)The factors influencing the proportion of the cross-region admission The number of beds for the acute psychiatric patients was the major factor affecting the proportion of cross-region admission for emergency mental patients in 1997. In 2001, the impact of the medical resources has noticeably been lowered indicating the supply of the beds has met the needs of the patients somewhat. For the chronic patients, the major factor affecting the proportion of cross-region admission in 1997 was the number of beds for the acute psychiatric patients. This indicates the chronic patient has taken the bed intended for the acute patients, and the phenomenon was widespread. However, in 2001 the number of beds for the chronic patients has become a major factor affecting the proportion of cross-region admission. This in turn indicates the supply of resources has made a remarkable contribution. From the conclusions we reached above, we strongly recommend that the government should continue to encourage private funding for setting up psychiatric institutions and to balance the interregional resources development to improve the accessibility of psychiatric care for the mentally ill.
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