Length of Stay and Direct Medical Costs for Psychogeriatric Inpatients in Taiwan

台灣老年精神住院病患住院天數與直接醫療成本之分析

10.29478/TJP.201112.0004

劉金明(Chin-Ming Liu)；利菊秀(Chu-Shiu Li)；劉純之(Chwen-Chi Liu)；杜珠錦(Chu-Chin Tu)

length of stay ； direct medical cost ； geriatrics

台灣精神醫學

25卷4期（2011 / 12 / 01）

248 - 260

英文

Objective: In this study, we aimed to analyze the length of stay (LOS) and direct medical costs (DMC) for psychogeriatric inpatients in Taiwan. Methods: We obtained the data from the Psychiatric Inpatient Medical Claim database of Taiwan's National Health Insurance. LOS and DMC of different mental illnesses were analyzed. Results: The average LOS of our study patients was 43.53 days, and the mean DMC was 2,576 US dollars. Dementia was the most common psychiatric diagnosis. Average LOS and DMC were significantly higher in male patients than female (p ＜ 0.001 and p = 0.022, respectively). Over 90% of DMC were non-drug expenses (NDE). The LOS of patients with dementia and major depression was significantly higher for males than for females (p ＜ 0.001). Patients' LOS and DMC showed differences among gender, diagnosis, and type of hospital. The LOS of dementia and delusional disorders and the DMC of major depressive disorders had heterogeneities across hospital types. The results of regression analysis indicated the LOS and the DMC of schizophrenic patients were significantly higher than those of dementia patients (p ＜ 0.001); the LOS of community hospitals was significantly higher (p ＜ 0.001) than that of general hospitals (medical centers and regional hospitals), with the opposite being true for DMC. Compared to public hospitals, the drug expense (DE) was significantly higher in private hospitals (p ＜ 0.04), but LOS and NDE were lower. Conclusion: The determinants affecting differences of LOS and DMC of psychogeriatric inpatients were gender, psychiatric diagnosis, and type of hospital. The DE and NDE of DMC were about 10% and 90%, respectively, but only the NDE showed significant difference based on gender.

1. Wang, K. I.,Cheng, S. H.(2006).The analysis of level of outpatient visits and healthcare utilization: a before and after observation of the SARS outbreak.Taiwan Journal of Public Health,25,75-82.
   連結：
2. Yeh, L. L.,Lan, C. F.,Cheng, J. S.(2003).The utilization and expenditure of psychiatric services for patients with schizophrenia in Taiwan.Taiwan Journal of Public Health,22,194-203.
   連結：
3. Organization for Economic Co-operation and Development. Paris: OECD Health Data, 2008.
4. (2010).Population Projections for Taiwan Areas: 2008-2056..Taiwan:Council for Economic Planning and Development, Executive Yuan.
5. Bureau of National Health Insurance. Statistic Annual Report; 2011.
6. Akincigil, A.,Hoover, D. R.,Walkup, J. T.(2008).Hospitalization for psychiatric illness among community- dwelling elderly persons in 1992 and 2002.Psychiatr Serv,59,1046-8.
7. Blank, K.,Hixon, L.,Gruman, C.,Robison, J.,Hickey, G.,Schwardz, H. I.(2005).Determinants of geropsychiatric inpatient length of stay.Psychiatr Quart,76,195-212.
8. Chan, A. L.,Cham, T. M.,Lin, S. J.(2009).Direct medical costs in patients with Alzheimer's disease in Taiwan: a population-based study.Curr Ther Res Clin,70,10-8.
9. Chien, I. C.,Chou, Y. J.,Lin, C. H.,Bih, S. H.,Chou, P.(2004).Prevalence of psychiatric disorders among National Health Insurance enrollees in Taiwan.Psychiatr Serv,55,691-7.
10. Chong, S. A.,Verma. S.,Vaingankar, J. A.,Chan, Y. H.,Wong, L. Y.,Heng, B. H.(2007).Perception of the public towards the mentally ill in developed Asian country.Soc Psychiatry Psychiatr Epidemiol,42,734-9.
11. Chung, W.,Cho, W. H.,Yoon, C. W.(2009).The infl uence of institutional characteristics on length of stay for psychiatric patients: a national database study in South Korea.Soc Sci Med,68,1137-44.
12. Chung, W.,Oh, S. M.,Suh, T.,Lee, Y. M.,Oh, B. H.,Yoon, C. W.(2010).Determinants of length of stay for psychiatric inpatients: analysis of a national database covering the entire Korean elderly population.Health Pol,94,120-8.
13. Grassi, L.,Biancosino, B.,Marmai, L.(2006).Violence in psychiatric units: a 7-year Italian study of persistently assaultive patients.Soc Psychiatry Psychiatr Epidemiol,41,698-703.
14. Hung, J. H.,Li, C.(2008).Has cost containment after the National Health Insurance system been successful? determinants of Taiwan hospital costs.Health Policy,85,321-35.
15. Imai, H.,Hosomi, J.,Nakao, H.(2005).Characteristics of psychiatric hospitals associated with length of stay in Japan.Health Pol,74,115-21.
16. Lin, M. J.,Luoh, M. C.(2008).Can Hepatitis B mothers account for the number of missing women? Evidence from three million newborns in Taiwan.Am Econ Rev,98,2259-73.
17. Lin, T. F.(2009).1949 Great Retreat.Taipei:Linking Publications.
18. Nosé, M.,Barbui, C.,Tansella, M.(2003).How often do patients with psychosis fail to adhere to treatment programmes? a systemic review.Psychol Med,33,1149-60.
19. Sellwood, W.,Tarrier, N.(1994).Demographic factors associated with extreme non-compliance in schizophrenia.Soc Psychiatry Psychiatr Epidemiol,29,172-7.
20. Su, C. B.,Peng, T. G.,Teng, J. H.(2001).The relationship between resource advantage, strategic advantage, and performance under the department of health.Journal of Healthcare Management,2,93-109.
21. Theurl, E.,Winner, H.(2007).The impact of hospital fi nancing on the length of stay: evidence from Austria.Health Pol,82,375-89.
22. Wang, G.,Cheng, Q.,Zhang, S.(2008).Economic impact of dementia in developing countries: an evaluation of Alzheimer-type dementia in Shanghai, China.J Alzheimers Dis,15,109-15.