| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 101 === Objective:
Since 1995 we began to have the implementation of universal health insurance system, and medical expenses increased year by year; in order to control its growth rate, total health care global budget system was fully implemented in July 2002. In terms of catastrophic illness to analyze the cost of hospitalization, chronic mental illness ranked third highest, which will occupy most of schizophrenia medical resource utilization.
As in Taiwan, there are two distinct types of medical institutions to provide medical care of psychiatric patients, i.e. , integrated psychiatric hospitals and general hospitals, so the purpose of this study was to : (1) determine patients with schizophrenia demographics, disease characteristics, mental health institutions patterns, and acute inpatient care utilization correlation; (2) compare medical utilization of acute hospitalization of schizophrenia in mental hospitals and general ones; (3)compare medical utilization of acute hospitalization of schizophrenia in mental hospitals and general ones before and after the implementation of the global budget.
Methods:
This study is a retrospective study, and captures the NHI database. Duration of study time is 1 January 1996 to 31 December 2010, a total of 15 years of inpatient data, with research sample selection approach including the first principal diagnosis code of 295, i.e., patients with schizophrenia. There were 7,122 patients. Since the global budget payment system was nationally applied in July 2002, our research will serve as the point in time after the intervention system: January 1, 1996 to June 30, 2002 before the implementation of the system in 2002 July 1 date to December 31, 2010 as the system is implemented. Medical expenses to the hospital to BNHI points, 1 point = NT $ 1 is expressed and released by DGBAS, 2010 as the base year consumer price index (CPI), inflation adjustments .
SPSS 18.0 statistical software packages was used of descriptive statistics, chi-square test and multiple regression analysis, independent sample t test, and repeated measures ANOVA, to verify our research hypotheses.
Results:
The results showed that the total medical costs, the total number of hospital stay, other physical complications, psychiatric hospital and age to predict the variables, and gender and the presence or absence of catastrophic illness cards no significant difference. The total number of hospital stay per additional day will increase the total medical costs 1,244 NTD, those who had other physical complications increased by 66,323 NTD than those who have not , psychiatric hospitals increased 66,536 NTD than in general hospitals, more than a year old of age decreased 559 NTD. Cost per man-day, all variables showed a statistically significant difference: those who had catastrophic illness cards expenses less by 238 NTD per person per day, males more than females by 67 NTD, psychiatric hospitals increased by 94 NTD, those who had other physical complications increased more than 57 NTD, and one year old of age increased 1.29 NTD. General hospital had longer total number of inpatient stay; average length of stay is 52.97 and psychiatric hospitals is 44.81 days (P <0.0005); total medical expenses the two are not statistically significant differences , but the average cost per day is higher in psychiatric hospital with 2,019 NTD than 1,958 NTD in general ones . The implementation of the global budget payment system, different mental health institutions and patterns of interaction between the two were associated with significant different in total medical expenses and medical expenses per person per day; total medical expenses and per person day medical expenses were significantly high after the implementation of the system, and also higher in the psychiatric hospitals. The impact of global budget payment system for enhancing the total medical expenses and medical expenses per day on the psychiatric hospitals is significantly higher than the general ones.
Conclusion and Suggestion:
As the results described in our research, acute hospitalization of patients with schizophrenia in psychiatric hospitals and general hospitals had significantly different health care utilization; in the total number of inpatient days general hospitals is greater than psychiatric hospital, but the average length of stay and the average daily cost in the latter is greater than the former. Total medical expenses and medical expenses per day were growing after payment systemwas implemented, and also higher than in the psychiatric hospitas. The impact of global budget payment system for enhancing the total medical expenses and medical expenses per day on the psychiatric hospitals is significantly higher than the general ones.
This study suggests that mental health institutions should develop according to their different treatment modalities appropriate clinical treatment guidelines and specifications, use of health care resources, and to strengthen the quality of health care maintenance and advancement of the limited medical resources for the most efficient use.
|
|---|
