目的：自2007年7月精神衛生法修正公布後，顯見社會已正視精神障礙者之權益；精神疾病與部分慢性病之關聯性已有所證實，但精神病患者於慢性病相關之醫療使用支出，是否會因自身精神狀況而有所影響，為本研究所想釐清與深究。

方法：本研究採用2001年~2007年之全民健保資料庫數據，使用SPSS統計軟體分析2004年確診之精神病患者及其對照組，於2004年前後(2001-2003年比對2005-2007年)在共病性關係最顯著的三項慢性病(糖尿病、高血壓與高血脂)科別，其醫療資源的使用情形是否與一般就醫民眾相同。本研究為精確研究對象，故設定排除未滿18歲，研究組選擇2001-2003年間無任何精神科相關診斷紀錄者，且2004年有精神科診療紀錄者；而對照組則是以2001-2007年間從未有精神科相關診斷紀錄，且與研究組相同年齡、性別條件，以隨機方式以1：1的比例，分別找出26275人，取得健保資料庫中相關資料進行分析。

結果：是否為精神科患者、2004年前後不同時期、與性別等三項，在各年分別與各項醫療資源相關指標中，皆呈顯著差異；其中在慢性病相關門診住院部分，2004年前後的門診平均費用部分，精神科患者較一般民眾使用較少之慢性病門診醫療資源，且差距逐漸拉大；住院平均費用方面則略為相反，2004年以前精神科患者並未與一般民眾有顯著差異，但2004年之後則較一般民眾使用較多之住院醫療資源。整體而言，本研究並未發現精神科病患在就醫2004年於精神科就醫後，因而大幅改變其慢性病相關之醫療資源使用習慣。


關鍵字：精神疾病、醫療資源、慢性病、資源使用、全民健保資料庫

Object: Psychiatric patients have a high prevalence of chronic medical illness, such as diabetes, hypertension and hypercholesterolemia. Although mental illness might change the method of using medical service, in this study we would like to identify the utilization between psychiatric and non-psychiatric patients in chronic diseases related outpatient department.

Method: The data were collected from the National Health Insurance database. The study periods were 2001-2003 and 2005-2007. Descriptive analysis, paired-sample t-test, repeated measures ANOVA within and between factors and multiple linear regression were used in this study. The study focus on three major chronic disease which highly relative to psychiatric patients, by using the data of from the National Health Insurance database we can analyze and tell the difference of the utilization between psychiatric and non-psychiatric patients in chronic diseases.

Results: Three characteristics were found significant difference when analyzing six indicators of the outpatient expenses in chronic diseases, which were psychiatric patients, before or after year of 2004, and gender differences. Psychiatric patients tend to have lesser medical expenses compared to those who are not psychiatric patients (between 2001-2007), and the difference of usage within 2005-2007 were significantly larger than the usage within 2001-2003.

There were no significant differences between psychiatric and non-psychiatric patients while analyzing the hospitalization costs within 2001-2003. However the difference was shown by analyzing the data within 2005-2007. Psychiatric patients spent more medical resources than non-psychiatric patients did.

As a result, no evidence was shown that psychiatric patients would change their method of using medical service after being diagnosed in psychiatric.


Key words : Mental illness, Medical resources, Chronic, Utilization, National Health Insurance database

論文審定書 I
中文摘要 II
ABSTRACT III
目 錄 IV
圖 次 V
表 次 V
第一章 緒論 6
第一節 研究背景及動機 6
第二節 研究目的 7
第二章 文獻查證 8
第一節 精神醫療 8
第二節 慢性病定義及其影響 10
第三節 相關醫療資源利用之研究 11
第四節 文獻總結 15
第三章 研究方法 16
第一節 研究設計與架構 16
第二節 研究變項 18
第三節 研究問題 20
第四節 研究假設 21
第五節 資料來源及研究對象 22
第四章 研究分析與結果 23
第一節 基本資料及就醫特性 23
一、 基本資料分析： 23
二、 就醫特性： 24
第二節 使用之醫療資源 28
三、 各項目於不同年度之使用情形 28
第三節 慢性病相關門住診醫療資源分析 32
四、 使用spss之檢定結果 32
五、 Repeated measures ANOVA within and between factors(重複測量變異數分析) 37
六、 不同性別於各項醫療資源使用指標之歷年趨勢 39
七、 歷年醫療資源使用與各項因素之迴歸分析 46
八、 研究結果摘要： 59
九、 假設驗證 61
第五章 討論與建議 63
第一節 研究討論 63
第二節 研究限制 65
第三節 建議 66
參考文獻 67
一、 中文文獻： 67
二、 英文文獻： 69
三、 附錄 71

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