Huang Chun-Jen, Liu Tai-Ling, Huang Yu-Ting, Hsieh Hui-Min, Chang Chih-Cheng, Chu Chin-Chen, Wei Chun-Wang, Weng Shih-Feng
Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, San Ming District, Kaohsiung, 807, Taiwan.
Eur Arch Psychiatry Clin Neurosci. 2022 Apr;272(3):519-529. doi: 10.1007/s00406-021-01258-8. Epub 2021 Apr 15.
This study investigated healthcare utilization and expenditure for patients with type 2 diabetes mellitus and schizophrenia and associated factors. Healthcare utilization (outpatient visits and hospitalization) and expenditure (outpatient, inpatient, and total medical expenditure) between 2002 and 2013 of patients with T2DM with schizophrenia (case group) and without (control group) were examined using the Taiwan National Health Insurance Research Database. (1) The average total numbers of outpatient visits and hospital admissions of the case group were 35.14 outpatient visits and 1.09 hospital admissions significantly higher than those of the control group in the whole study period (based on every 3-year period). Nonpsychiatric outpatient visits and nonpsychiatric hospital admissions were significantly more numerous for the case group. (2) The total outpatient expenditure, total inpatient expenditure, and total medical expenditure of the case group were NT$65,000, NT$170,000, and NT$235,000 significantly higher than those of the control group, respectively. Nonpsychiatric outpatient expenditure was significantly lower for the case group, but the inpatient and total nonpsychiatric medical expenditure were similar between groups. (3) Patients who were elder of low income, with complications, and high diabetes mellitus complication severity index had higher total numbers of outpatient visits and hospitalizations and medical expenditure. (4) Women had a higher number of outpatient visits but a lower number of hospitalization and medical expenditure. Lower non-psychiatric outpatient expenditure despite more visits indicated non-psychiatrist may not understand schizophrenia patients and cannot communicate well with them, leading to neglect of medical evaluation and treatment that should be carried out.
本研究调查了2型糖尿病合并精神分裂症患者的医疗服务利用情况、医疗支出及其相关因素。利用台湾全民健康保险研究数据库，对2002年至2013年期间患有精神分裂症的2型糖尿病患者（病例组）和未患精神分裂症的患者（对照组）的医疗服务利用情况（门诊就诊和住院）及支出（门诊、住院和总医疗支出）进行了研究。（1）病例组的门诊就诊和住院的平均总数分别为35.14次门诊就诊和1.09次住院，在整个研究期间（以每3年为一个时间段）显著高于对照组。病例组的非精神科门诊就诊和非精神科住院次数明显更多。（2）病例组的门诊总支出、住院总支出和总医疗支出分别为新台币65,000元、170,000元和235,000元，显著高于对照组。病例组的非精神科门诊支出显著较低，但两组之间的住院和非精神科总医疗支出相似。（3）年龄较大、低收入、有并发症以及糖尿病并发症严重程度指数较高的患者，其门诊就诊、住院次数和医疗支出较多。（4）女性的门诊就诊次数较多，但住院次数和医疗支出较少。尽管就诊次数较多，但非精神科门诊支出较低，这表明非精神科医生可能不了解精神分裂症患者且无法与他们良好沟通，导致忽视了应进行的医疗评估和治疗。
