监狱中个人医疗保健支出的决定因素：来自瑞士的证据。
The determinants of individual health care expenditures in prison: evidence from Switzerland.
作者信息
Moschetti Karine, Zabrodina Véra, Wangmo Tenzin, Holly Alberto, Wasserfallen Jean-Blaise, Elger Bernice S, Gravier Bruno
机构信息
Institute of Social and Preventive Medicine, University of Lausanne and University Hospital of Lausanne (CHUV), Route de la Corniche 10, 1010, Lausanne, Switzerland.
Technology Assessment Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
出版信息
BMC Health Serv Res. 2018 Mar 7;18(1):160. doi: 10.1186/s12913-018-2962-8.
BACKGROUND
Prison health systems are subject to increasing pressures given the specific health needs of a growing and aging prison population. Identifying the drivers of medical spending among incarcerated individuals is therefore key for health care governance in prisons. This study assesses the determinants of individual health care expenditures within the prisons of the canton of Vaud, a large region of Switzerland.
METHODS
We use a unique dataset linking demographic and prison stay characteristics as well as objective measures of morbidity to detailed medical invoice data. We adopt a multivariate regression approach to model total, somatic and psychiatric outpatient health care expenditures.
RESULTS
We find that chronic infectious, musculoskeletal and skin diseases are strong predictors of total and somatic costs. Schizophrenia, neurotic and personality disorders as well as the abuse of illicit drugs and pharmaceuticals drive total and psychiatric costs. Furthermore, cumulating psychiatric and somatic comorbidities has an incremental effect on costs.
CONCLUSION
By identifying the characteristics associated with health care expenditures in prison, this study constitutes a key step towards a more efficient use of medical resources in prison.
背景
鉴于监狱人口不断增长且老龄化带来的特定健康需求，监狱卫生系统面临着越来越大的压力。因此，确定在押人员医疗支出的驱动因素是监狱医疗保健治理的关键。本研究评估了瑞士大片地区沃州监狱内个人医疗保健支出的决定因素。
方法
我们使用了一个独特的数据集，将人口统计学和监狱服刑特征以及发病率的客观测量与详细的医疗发票数据联系起来。我们采用多元回归方法对总的、躯体的和精神科门诊医疗保健支出进行建模。
结果
我们发现慢性传染病、肌肉骨骼疾病和皮肤病是总费用和躯体费用的有力预测因素。精神分裂症、神经症和人格障碍以及非法药物和药品滥用导致了总费用和精神科费用。此外，精神和躯体合并症的累积对费用有增量影响。
结论
通过确定与监狱医疗保健支出相关的特征，本研究朝着更有效地利用监狱医疗资源迈出了关键一步。
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