Cost-benefit analysis of the psychiatric patients after discharge from hospitals and follow-up at outpatient and transferring to institutions of psychiatric rehabilitation

• Main Authors: Yu-Hsuan Tsai, 蔡毓瑄
• Other Authors: Yong-Yuan Chang
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/71224181050485239271

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 1985, the community rehabilitation for the psychiatric patients is promoted. But there is no study on the cost-benefit analysis for the institutions of psychiatric rehabilitation till now. So this study will investigate the cost-benefit analysis of the psychiatric patients who discharged from hospitals, either following up at outpatient departments or transferring to institutions of psychiatric rehabilitation. Methods This study is an assessment study. The data is obtained from Normalized Million People File on 2000, National Health Insurance Research Database. We select the inpatient psychiatric patients who discharged on 2004.1.1 ~ 2008.12.31. The cases are divided to the group of outpatient follow-up and the group of psychiatric rehabilitation. We investigate the cost-benefit analysis for the medical resource utilizations within 2 year after discharge of these two groups, using chi-square t-test, independent t-test, binary logistic regression analysis, and the indicators of cost-benefit analysis(Net Present Value, Benefit-Cost Ratio, Internal Rate of Return). Results A total of 11,609 psychiatric patients are included. After normalizing, there is 4,373 cases in the study, 4,044 in the group of outpatient follow-up and 329 in the group of psychiatric rehabilitation. By using propensity score matching (PSM), we select 326 cases of each group for study. There is no significant difference in the demographic characteristics and clinical manifestations of these two groups. Our study is in the view of health insurance payers. The costs are direct and are analyzed by reporting points of NIH. From the indicators of cost-benefit analysis, we find that outpatient follow-up and psychiatric rehabilitation are both worth the investments. But the cost-benefit of the group of outpatient follow-up is better than that of psychiatric rehabilitation. By using Incremental Analysis, the program of psychiatric rehabilitation is disadvantaged. At last, the results of this study are stable and credible after Sensitivity Analysis. Conclusions and Suggestions Though there is no advantage in the cost-benefit of the group of psychiatric rehabilitation compared with the group of outpatient follow-up. Analyzing the data of the inpatient medical expenses in the group of outpatient follow-up, the average and total medical expenses in the second year is higher than the expenses in the first year. But the data in the group of psychiatric rehabilitation is converse. Due to following for 2 years only, we do not find out the trends of these two groups. Maybe prolong the years of following in the future study. We suggest the government should promote the institutions of psychiatric rehabilitation. Medical institutions should construct the system of case management. Medical professionals should encourage the medication adherence of patients and transfer the patients to the institutions of psychiatric rehabilitation for continuing rehabilitation treatment. Key words: psychiatric patients, institution of psychiatric rehabilitation, cost-benefit analysis, propensity score matching