A Study of Resource Utilization on Depressive Disorders in Taiwan

• Main Authors: Ching-Ming, Cheng, 鄭靜明
• Other Authors: Ching-Wen, Chien
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/68155153087493177683

碩士 === 國立陽明大學 === 醫務管理研究所 === 94 === Abstract No matter in the outpatient, emergency, or inpatient respects, the medical expenses of depressive disorders grow up year by year. If we can analyze the resource utilization of the depressive disorders, we should be able to make contributions to the limited utilization of the health insurance resources and the management respect of the hospital. The data for this study were collected from the Bureau of National Health Insurance (BNHI) database of 2004. We select the primary diagnosis code numbers of ICD-9-CM were 300.4 (neurotic depression), 296.2 (Major depressive disorder, single episode), 296.3 (Major depressive disorder, recurrent episode), 309.1 (Adjustment disorder with depressed mood) Or 311 (Depressive disorder, not elsewhere classified). This study attempts to examine the resource utilization and the influencing factors of depressive disorders in Taiwan. To analyze the extent to which the cost of acute psychiatric inpatient care and outpatient care is determined by the characteristics of patient (sex, age level, diagnosis , psychiatric cormorbidity ), characteristics of insurance (psychiatric catastrophic illness, exemptions of co-payments), and characteristics of hospital (hospital ownership, hospital type, accredited hospital levels, Branch of the Bureau of National Health Insurance). Our major findings are as follows: The factors associated with the length of stay of acute psychiatric inpatient are sex, age level, hospital ownership, and accredited hospital levels, Branch of the Bureau of National Health Insurance, diagnosis, catastrophic illness and exemptions of co-payments. The factors associated with the acute psychiatric inpatient medical expenditures are age level, hospital types, hospital ownership, accredited hospital levels, Branch of the Bureau of National Health Insurance, psychiatric catastrophic illness and exemptions of co-payments. The factors associated with the total ambulatory medical expenditures per visit are diagnosis, accredited hospital levels, Branch of the Bureau of National Health Insurance and psychiatric catastrophic illness. The factors associated with the consumption of ambulatory drug fees per visit are diagnosis, age level, accredited hospital levels, Branch of the Bureau of National Health Insurance, exemptions of co-payments and psychiatric catastrophic illness. The length of stay of acute psychiatric inpatient is higher in the Male depressive disorders than the female depressive disorders. There is no sex difference of resource utilization in the acute psychiatric inpatient medical expenditures, the total ambulatory medical expenditures per visit and the consumption of ambulatory drug fees per visit. Patients diagnosed with major depressive disorder are higher than patients with other diagnosis in the length of stay of acute psychiatric inpatient, the acute psychiatric inpatient medical expenditures, the total ambulatory medical expenditures per visit, and the consumption of ambulatory drug fees. Patients with psychiatric catastrophic illness are higher than patients without psychiatric catastrophic illness in the length of stay of acute psychiatric inpatient, the acute psychiatric inpatient medical expenditures, the total ambulatory medical expenditures per visit and the consumption of ambulatory drug fees. Patients with exemptions of co-payments are higher than patients without exemptions of co-payments in the length of stay of acute psychiatric inpatient, the acute psychiatric inpatient medical expenditures and the consumption of ambulatory drug fees. Based on the above finding, we have following recommendations: The geographic variation of medical utilization is the important issue on the reforms of the NHI reimbursement programs. In the future, it should be evaluated the possibility of capitation under depressive disorders. Bureau of National Health Insurance should pay more attention to the management with psychiatric catastrophic illness of depressive disorders. The hospital needs to pay highly attention to the management with psychiatric catastrophic illness of depressive disorders. Setting up the acute ward of geriatric depressive disorders is suggested if necessary. It is recommended to establish a therapeutic guideline for acute inpatient and outpatient treatment program of depressive disorders.