EXPLORING MEDICAL UTILIZATION BY PATIENTS WITH AUTISM IN TAIWAN

EXPLORING MEDICAL UTILIZATION BY PATIENTS WITH AUTISM IN TAIWAN

10.6831/TMU.2012.00008

王莉

Autism ； medical utilization ； ambulatory care ； hospitalization ； expenditure ； Autism ； medical utilization ； ambulatory care ； hospitalization ； expenditure

臺北醫學大學醫務管理學研究所學位論文

2012年

碩士

林恆慶

英文

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.

1. Psychoactive Medicines Among Individuals with Autism in the Autism Society of Ohio.
   連結：
2. Journal of Autism and Developmental Disorders, 33, 527–534.
   連結：
3. American Psychiatric Association (1994), Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV),Washington, DC: American Psychiatric Association.
   連結：
4. American Psychiatric Association [APA](2000). Diagnostic and statistical manual of Mental Disorders (4th ed.),Washington , DC.
   連結：
5. April Young, Lisa Ruble & John McGrew, (2009). Public vs. Private Insurance: Cost, Use, Accessibility, and Outcomes of Services for Children with Autism Spectrum Disorders. Research in Autism Spectrum Disorders, 3,1023–1033.
   連結：
6. Bailey A, Phillips W, Rutter M. (1996). Autism: towards an integration of clinical, genetic, neuropsychological, and neurobiological perspectives. Journal Child Psychology Psychiatry. 37:89–126.
   連結：
7. Battaglia A., (2007). On the Selection of Patients with Developmental Delay / Mental Retardation and Autism Spectrum Disorders for Genetic Studies. American Journal Medical Genetic, 143, 789-790.
   連結：
8. Bauman, M.L. (2010). Medical Co-morbidities in Autism: Challenges to Diagnosis, Treatment. Journal of American Society for Experimental Neuro Therapeutics, 7, 320-327.
   連結：
9. Blaxill MF, Redwood L, Bernard S.,(2004). Thimerosal and autism? A plausible hypothesis that should not be dismissed. Med Hypotheses. 62:788 –794.
   連結：
10. Bristol MM, Cohen DJ, Costello EJ.,(1996). State of the science in autism: report to the National Institutes of Health. Journal Autism Developmental Disorders. 26:121–154.
    連結：
11. Center for Disease Control (CDC). Retrieved from http://www.ialq.org/awareness-campaign/, 30/5/2011.
    連結：
12. Chen, C. Y., Liu, C. Y., Su, W. C., Huang, S. L., & Lin, K. M. (2007). Factors associated with the diagnosis of neurodevelopmental disorders: A population-based longitudinal study. Pediatrics, 119, 435–443.
    連結：
13. Chun-Zi Peng, Preston Hatlestad, Marilyn G. Klug, Jacob Kerbeshian & Larry Burd (2011). Health Care Costs and Utilization Rates for Children with Pervasive Developmental Disorders in North Dakota From 1998 to 2004: Impact on Medicaid. Journal of Children Neurology, 25: 4-31.
    連結：
14. Churn-Shiouh G. et al. (2007). Usage of the claim database of national health insurance programme for analysis of cisapride-erythromycin co-medication in Taiwan. Pharmaco- epidemiology and drug safety, 16:86-95.
    連結：
15. Cooley WC. (2004). Redefining Primary Pediatric Care for Children with Special Health Care Needs: The Primary Care Medical Home. Pubmed, 16(6), 689-692.
    連結：
16. Croen, L.A. et al. (2006). A Comparison of Health Care Utilization and Cost of Children with and without Autism Spectrum Disorders in a Large group –Model Health Care Plan. American Academy of Pediatrics, 118, 1203-1211.
    連結：
17. David S. Mandell, Jun Cao, Richard Ittenbach & Jennifer Pinto-Martin (2006). Medicaid Expenditures for Children with Autistic Spectrum Disorders: 1994 to 1999. Journal of Autism and Developmental Disorders, Vol. 36(4), DOI 10.1007/s10803-006-0088-z.
    連結：
18. Dales L, Hammer SJ, Smith NJ., (2001). Time trends in autism and in MMR immunization coverage in California. Journal of the American Medical Association, 285:1183–1185.
    連結：
19. Deth R et al., (2008). How environmental and genetic factors combine to cause autism: a redox / methylation hypothesis. NeuroToxicology, 29:190–201.
    連結：
20. Flanders, S. C., Engelhart, L., Pandina, G. J., & McCracken, J. T. (2007). Direct health care costs for children with pervasive developmental disorders:1996–2002. Administration and Policy of Mental Health and Mental Health Services Research, 34, 213–220.
    連結：
21. Gregory S. Liptak, Tami Stuart & Peggy Auinger (2006). Health Care Utilization and Expenditures for Children with Autism: Data from U.S. National Samples. Journal of Autism Developmental Disorder, 36:871–879.
    連結：
22. Gurney, J.G., Mcpheeter, & Davis, M.M. (2006). Parental Report of health Conditions and Health Care Use Among Children with and without Autism. Archives of Pediatric and Adolescent Medicine, 160(8), 825-830.
    連結：
23. Heflin, L. J., & Simpson, R. L. (1998). Interventions for Children and Youth with Autism: Prudent Choices in a World of Exaggerated Claims and Empty promises. Part 1: Interview and Treatment Options review. Focus on the Other Developmental Disabilities, 13,194- 211.
    連結：
24. Howlin, P., Goode, S., Hutton, J., & Rutter, M.(2004). Adult Outcome for Children with Autism. Journal of Child Psychiatry, 45(2), 212-229.
    連結：
25. I-Chia C., et al. (2011). Prevalence and incidence of autism spectrum disorders among national health insurance enrollees in Taiwan from 1996 to 2005. Journal of Child Neurology, 26(9).
    連結：
26. Jacquelyn Bertrand et al., 2001. Prevalence of autism in a United Stated population: The Brick Township, New Jersey, investigation, 108; 1155-1161.
    連結：
27. James G. Gurney, Melissa L. McPheeters & Matthew M. Davis (2006). Parental Report of Health Conditions and Health Care Use Among Children With and Without Autism: National Survey of Children’s Health. Archives Pediatrics Adolescent Medicine, 160.
    連結：
28. Jin-Ding Lin et al. (2009). Administrative Prevalence of autism spectrum disorders based on national disability registers in Taiwan. Research in Autism Spectrum Disorders, 3, 269- 274.
    連結：
29. Jin-Ding Lin et al. (2010). Ten-Year Trend Analysis of Autism Severity: A National wide Population-Based Register Study. Research in Autism Spectrum Disorders.
    連結：
30. Jin-Ding Lin et al. (2011). Utilization and Expenditure of Hospital Admission in Patients with Autism Spectrum Disorder: National Health Insurance Database Analysis. Research in Autism Spectrum Disorders, 5 (3), 1138-1142.
    連結：
31. Kaye, J. A., Melero-Montes, M., and Jick, H., (2001). Mumps, measles and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. British Medical Journal, 322, pp. 460-463.
    連結：
32. Kirby D., (2005). Evidence of Harm: Mercury in Vaccines and the Autism Epidemic—A Medical Controversy. New York, NY: St Martin’s Press.
    連結：
33. Kohler, F. (2000). Examining the Services Received by Young Children with Autism and Their Families: A Survey of Parent Responses, 14 , 150-158.
    連結：
34. Kraus et al. (2003). Access to Specialty Medical Care for Children with Mental Retardation, Autism and Other Special Health Care Needs. Journal of Mental Retardation, 41, 329- 339.
    連結：
35. Lang worthy-Lam, K. S., Aman, M. G., & Van Bourgondien, M. E. (2002). Prevalence and Patterns of Use of Psychoactive Medicines in Individuals with Autism in the Autism Society of North Carolina. Journal of Child and Adolescent Psychopharmacology,12, 311–321.
    連結：
36. Levitt P, Campbell DB., (2009). The genetic and neurobiologic compass points toward common signaling dysfunctions in autism spectrum disorders. Journal Clinical Investigation. 119(4): 747–54.
    連結：
37. Liptak, G. S., Stuart, T., & Auinger, P. (2006). Health care utilization and expenditures for children with autism: Data from U.S. national samples. Journal of Autism and Developmental Disorders: 36, 871–879.
    連結：
38. Lisa A.Croen, Daniel V. et al., 2006. A comparison of health care utilization and costs of children with and without autism spectrum disorders in a large group-model health care plan. Pediatrics official journal of the American academy of pediatrics, 118: e1203e1211.
    連結：
39. Loat CS et al., (2008). Methyl-CpG-binding protein 2 polymorphisms and vulnerability to autism. Genes Brain Behavior 7(7): 754–760.
    連結：
40. Lord, C. R.M., Le Couteur, A. (1994). Autism Diagnostic Interview-Revised Version of a Diagnostic Interview for Caregiver of Individuals with Possible Pervasive Developmental Disorders. Journal of Autism Developmental Disorder, 659-685.
    連結：
41. Lord C, Rutter M, Goode S, Heemsbergen J, Jordan H, Mawhood L, Schopler E (1989). Autism diagnostic observation schedule: A Standardized Observation of Communicative and Social Behavior. Journal of Autism Developmental Disorders, 19,185–212.
    連結：
42. Lotter V. (1966). Epidemiology of autistic conditions in young children: I. Prevalence. Social Psychiatry: 1, 124–137.
    連結：
43. Mandell, D. S., Cao, J., Ittenbach, R., & Pinto-Martin, J. (2006). Medicaid expenditures for children with autistic spectrum disorders: 1994 to 1999. Journal of Autism and Developmental Disorders, 36(4), 475–485.
    連結：
44. Martin, A., Scahill, L., Klin, A., & Volkmar, F.R. (1999). Higher functioning Pervasive Developmental Disorders: Rates and patterns of psychotropic drug use. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 923–931.
    連結：
45. McDermott Suzanne., Li Zhou & Mann Joshua (2007). Injury Treatment among Children with Autism or Pervasive Developmental Disorder. Springer Science.
    連結：
46. Melissa. Mapheefers et al. (2011). A Systematic Review of Medical Treatment for Children with Autism Spectrum Disorders. Official Journal of the American Academy of Pediatrics.
    連結：
47. Michael D. et al., (2009). Prevalence of parent-reported diagnosis of autism spectrum disorders among children in US,2007. Pediatrics, 124; 1395-1495.
    連結：
48. Myers, S.M., Johnson, C., & The Council on Children with Disabilities [CCD] (2007). Management of Children with Autism Spectrum Disorders. American Academy of Pediatrics, 29, 1162-1182.
    連結：
49. News Chaffer, C.J., & Curran, L.K. (2003). Autism: An Emerging Public Health Problem. Public Health Reports. 118, 393-399.
    連結：
50. Nevels, R.M. et al. (2007). Psychopharmacology of Aggression in Children and Adolescents with Primary Neuropsychiatric Disorders: A Review of Current and Potentially Promising Treatment Options. Experimental and Clinical Psychopharmacology: 18(2) 284-301.
    連結：
51. Paul T. Shattuck et al. (2011). Post–High School Service Use Among Young Adults With an Autism Spectrum Disorder. American Medical Association, Archives of Pediatrics and Adolescent Medicine: V.165 (2).
    連結：
52. Peggy Taylor, Stephanie Bryson, &Susan K. Corrigan (2006). Service Delivery to Children with Autism Spectrum Disorders. Office of Child Welfare and Children’s Mental Health.
    連結：
53. Peng, C., Hatlestad, P., Klug, M. G., Kerbeshian, J., & Burd, L. (2009). Health care costs and utilization rates for children with pervasive developmental disorders in North Dakota from 1998 to 2004: Impact on Medicaid. Journal of Child Neurology, 24(2), 140–147.
    連結：
54. Powell JE., et al. (2000). Changes in the incidence of childhood autism and other autistic spectrum disorders in preschool children from two areas of the west midlands, UK. Developmental Medicine & Child Neurology, 42(9): 624-8.
    連結：
55. Rice, C. (2007). Prevalence of Autism Spectrum Disorder – Autism and Developmental Disabilities Monitoring Network. 56, 12-28.
    連結：
56. Ruble et al. (2005). Access and Service Use by Children with Autism Spectrum Disorders in Medicaid Managed Care. Journal of Autism and Developmental Disorders: 35(1), 3-31.
    連結：
57. Rutter M. (2000). Genetic studies of autism: from the 1970s into the millennium. Journal Abnormal Child Psychology, 28: 3–14.
    連結：
58. Scambler, D.J., Hepburn, S.L., Rogers SJ (2006). A Two-year Follow up on Risk Status Identified by the Checklist for Autism in Toddlers. Journal Developmental Behavior Pediatric, 27: S104–S110.
    連結：
59. Shen, Y., et al. (2010). Clinical Genetic Testing for Patients with Autism Spectrum Disorders. American Academy of Pediatrics.
    連結：
60. Shimabukuro, T. T., Grosse, S. T., & Rice, C. (2008). Medical expenditures for children with an autism spectrum disorder in a privately insured population. Journal of Autism and Develop- mental Disorders: 38, 546–552.
    連結：
61. Steven P. Cuffe, Charity G. Moore & Robert McKeown (2009). ADHD and Health Services Utilization in the National Health Interview Survey. Journal of Attention Disorders:12(4) 330-340.
    連結：
62. Sugiyama Toshiro and Abe Tokuichiro (1989). The Prevalence of Autism in Nagoya, JAPAN: A Total Population Study. Journal of Autism and Developmental Disorder: 19(1), 87- 96.
    連結：
63. Tasneem Lokhandwala , Rahul Khanna & Donna West-Strum (2011). Hospitalization Burden Among Individuals with Autism. Journal of Autism Developmental Disorders, DOI 10.1007/s10803-011-1217-x.
    連結：
64. Taylor B, Miller E, Farrington CP, et al., (1999). Autism and measles, mumps and rubella vaccine: no epidemiological evidence for a causal association. Lancet 353: 2026–2029.
    連結：
65. Thomas, K. C., Ellis, A. R., McLaurin, C., Daniels, J., & Morrissey, J. P. (2007). Access to care for autism-related services. Journal of Autism and Developmental Disorders, 37, 1902– 1912. 69.
    連結：
66. Tom T., Shimabukoro, S.D.G., Catherine Rice, (2007). Medical Expenditures for Children With an Autism Spectrum Disorder in a Privately Insured Population. Journal of Autism and Developmental Disorders; 38(3): 546-552.
    連結：
67. Wakefield AJ, Murch SH, Anthony A, et al.,(1998). Ileal-lymphoid- nodular hyperplasia, non- specific colitis, and pervasive developmental disorder in children. Lancet. 351:637– 641.
    連結：
68. Webb EV. et al., ( 1997). The Changing Prevalence of Autistic Disorder in a Welsh Health District. Developmental Medicine Child Neurology, 39 (3), 150-152.
    連結：
69. Wing L. & Potter D., (2002). The epidemiology of autistic spectrum disorders: is the prevalence rising? Mental Retardation Developmental Disability Research Reviews, 8(3): 151-61.
    連結：
70. Wink, L.K., Ericson, C.A., & McDougle, C.J. (2010). Phamacologic Treatment of Behavioral Symptoms Associated with Autism and Other Pervasive Developmental Disorders. Current Treatment Options in Neurology, 12(6), 529-538.
    連結：
71. World Health Organization [WHO] (1992). The ICD-10 Classification of Mental and Behavioral Disorders. WHO, Geneva.
    連結：
72. Yahya M. AI-Farsi et al., 2011. Brief report: prevalence of Autistic spectrum Disorders in the Sultanate of Oman. Journal of autism Developmental Disorders, 41:821-825.
    連結：
73. Young-Shin Kim et.al.,(2011). Prevalence of autism spectrum disorders in a total population sample. American Journal of Psychiatry.
    連結：
74. Zwaigenbaum, L., Thurm, A., Stone, W., Baranek, G., Bryson, S., Iverson, J., Kau, A., Klin, A., Lord, C., Landa, R., Rogers. S., Sigman, M. (2007). Studying the Emergence of Autism Spectrum Disorders in High-Risk Infants: Methodological and Practical Issues. Journal of Autism Developmental Disorders, 37:466–480.
    連結：
75. Aman, M. G., Lam, K. S., & Collier-Crespin, A. (2003). Prevalence and Patterns of Use of
76. Andersen R, Davidson P. (2007). Improving access to care in America: individual and contextual indicators. In: Andersen R, Rice T, Kominski J, eds. Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management. San Francisco, CA: Jossey-Bass, 3–31.
77. Andersen, Glen.,(2001). Finding the Causes of Childhood Diseases. State Legislatures magazine. Angela G., (2005). Testing the behavioral model of health services use for a disabled population. North Carolina State University.
78. Autism Society of America [ASA]. Retrieved from “http://www.definitionofautism.com/”, 17 /4 /2011.
79. Bargh, J.A. ( 2000). Autism In A. E. Kazden (Ed.), Encyclopedia of Psychology, Vol.1, New York: Oxford University.
80. Data & Statistics; Prevalence. Retrieved from “http://www.cdc.gov/ncbddd/autism/data.html”, 17 / 4/2011.
81. Department of Health (2004). General Health Statistics, Taiwan area, R.O.C. Taipei, Taiwan. Retrieved from http://www.doh.gov.tw. 2011/4/28.
82. Flanders, S. C., Engelhart, L., Whitworth, J., Hussein, M. A., Vanderpoel, D. R., & Sandman, T. (2006). The economic burden of pervasive developmental disorders in a privately insured population. Managed Care Interface, 19(8), 39–45.
83. Ganz M.L., Boca Raton, Fla: Taylor and Francis Group; (2006). The costs of autism in: Moldin SO, Rubenstein JLR, eds. Understanding Autism: From Basic Neuroscience to Treatment.
84. Hua-Tsung-Yi-Tzu (1997). The Taiwan Physically and Mentally Disabled Citizens Protection Act (1997).
85. Institute of Medicine, Immunization Safety Review Committee.,(2001). Immunization Safety Review: Measles-Mumps-Rubella Vaccine and Autism. Stratton K, Gable A, Shetty P, McCormick M, eds. Washington, DC: National Academies Press.
86. Kemper TL, Bauman M.,(1998). Neuropathology of infantile autism. Journal Neuropathology Experimental Neurology. 57:645–652.
87. Kennedy Krieger Institute survey, (2009). Retrieved from http://www.ialq.org/research- information/statistics/ on 29/4/2011.
88. Levine, P., Marder C., Wagner, M. (2004). Services and Supports for Secondary School Students With Disabilities. Menlo Park, CA: SRI International.
89. Liu, C. Y., Hung, Y. T., Chuang, Y. L., Chen, Y. J., Weng, W. S., Liu, J. S., Liang, K. Y. (2006). Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. Journal of Health Management: 4, 1–22.
90. Lord, C., C.C (2005). Diagnostic Instrument in Autism Spectrum Disorders. In: Voiker FR, Paul R, Klin A, Cohen DJ. (eds) Handbook of Autism and Pervasive Developmental Disorders, 3rd edn. Wiley, Hoboken, NJ.
91. Lord C, Risi S, Lambrecht L, Cook EH Jr, Leventhal BL, DiLavore PC, Pickles A, Rutter M. (2000). The Autism Diagnostic Observation Schedule-Generic: A Standard Measure of Social and Communication Deficits Associated with the Spectrum of Autism. Journal of Autism Developmental Disorders, 30, 205–223.
92. Louis A. Vismara MD. (2009). The Demographics of Autism in California: Overview and Current Status.
93. Retrieved from http://autisminnb.blogspot.com/2011/01/autism-speaks-cdc-autism- prevalence.html, 18/ 4/2011.
94. Retrieved from http://www.cdc.gov/ncbddd/autism/data.html., 18/4/2011.
95. Retrieved from “http://www.autism-world.com/index.php/”autistics-of-autism-in-china/, 28/5/2011.
96. Retrieved from http://www.docstoc.com/docs/30862913/The-Application-of-Modeling-and- Simulation-to-Autism, 28/5/2011).
97. Retrieved from http://www.autismspeaks.org/whatisit/index.php, 2/6/2011.
98. Retrieved from http://www.autismspeaks.org/whatisit/index.php, 30/6/2011.
99. Retrieved from http://www.cdc.gov/ncbddd/autism/data.html, 26/8/2011.
100. Retrieved from http://www.autism.org.uk/about-autism/some-facts-and- statistics/statistics- how-many-people-have-autism-spectrum-disorders.aspx., 17/09/2011.
101. Retrieved form Incidence Numbers from Other Countries.” Autism Society. N.p., n.d.Web.3Sept.2010. , 18 /10 /2011.
102. Retrieved from http://www.earlysignsofautism.com/what-is-the-global-incidence-of-autism/, 20/10/2011.
103. Retrieved from http://www.drugs.com/enc/autism.html, 25/10/2011.
104. Retrieved from http://nhird.nhri.org.tw/en/Background.html,11/5/2011
105. Retrieved from; http://en.wikipedia.org/wiki/Taiwan, 28/10/2011.
106. Sattler, J.M. (2002). Assessment of Children: Behavioral and Clinical Applications (4th ed.), La Mesa, CA: Jerome M Sattler Publishing.
107. The Application of Modeling and Stimulation to the Behavioral Deficit of Autism (2008). Retrieved from http://www.docstoc.com/docs/30862913/The-Application-of-Modeling- and-Simulation-to-Autism, 28/4/2011.
108. Water J. Jones et al., (2005). Impact of specialty clinic access and TEFRA eligibility on Medicaid expenditures and service delivery for autistic children: A preliminary analysis of South Carolina data. American Public Health Association.
109. What is Autism? Retrieved from “http://www.autismspeaks.org/whatisit/index.php”, 17/2/2011.