Prevalence, Use, and Costs of Psychiatric Disorders Among National Health Insurance Enrollees in Taiwan

• Main Authors: I-Chia Chien, 簡以嘉
• Other Authors: Pesus Chou
• Format: Others
• Language: en_US
• Published: 2004
• Online Access: http://ndltd.ncl.edu.tw/handle/52975827137639589522

博士 === 國立陽明大學 === 公共衛生研究所 === 92 === Objective: 96% of all residents of Taiwan in 2000 were enrolled in the National Health Insurance (NHI) program. The NHI database was used to detect the prevalence, use and costs of psychiatric disorders. We also used the NHI database from 1996 to 2001 to examine the prevalence and incidence of schizoprenia. Methods: The National Health Research Institute of Taiwan offered a database of 200,432 random subjects, about 1% of the population, for use in related studies. Persons under the age of 18 years and persons who were not eligible for NHI in 2000 were excluded, leaving 137,914 persons available for this study. Data from the 2000 NHI study were compared with data from a 1985 community survey (Taiwan Psychiatric Epidemiological Project) to determine how the prevalence rates of psychiatric disorders changed over the 15-year period. Besides, considering the use and costs, the enrollees were excluded if they were foreigners, or if they had not been continuously eligible and alive for all of the year 2000. Subjects were also limited to those age 18 and older. So, we analyzed 126,146 subjects, who were divided into four groups: no psychiatric disorder, minor psychiatric disorder, and major psychiatric disorder without or with catastrophic illness registration. Outcome measures also included mental and non-mental health care use and costs and their associated factors. Also, by means of exclusion criteria, we obtained a random sample of 136,045 subjects as a fixed cohort dated 1996–2001. Those study subjects who had at least one service claim during these years for either ambulatory or inpatient care, with a principal diagnosis of schizophrenia, were identified to study the prevalence and incidence. Results: The one-year prevalence rate of any major psychiatric disorder, any minor psychiatric disorder, and any psychiatric disorder was 1.37 percent, 4.26 percent, and 5.30 percent, respectively. The differences in prevalence rates between the sexes were significant for five major and nine minor psychiatric disorders. The prevalence rates for eight psychiatric disorders were lower in the 2000 NHI study than in the 1985 community survey. However, the prevalence rate of schizophrenic disorder was found to be higher in the 2000 study and the prevalence rate of bipolar disorder was found to be the same in both studies. The mean mental health care costs (US$) and standard errors (SEs) of minor psychiatric disorder, and major psychiatric disorder without or with catastrophic illness registration in 2000 were $84.8 (SE 14.8), $410.3 (SE 33.3), and $2151.6 (SE 39.5), respectively. The mean non-mental health care costs (US$) and SEs of no psychiatric disorder, minor psychiatric disorder, and major psychiatric disorder without or with catastrophic illness registration were $484.2 (SE 4.6), $739.2 (SE 22.0), $941.0 (SE 49.3), and $605.9 (SE 58.0), respectively. The cumulative prevalence of schizophrenia increased from 3.34 per 1000 to 6.42 per1000 from 1996 to 2001. The annual incidence density decreased from 0.95 per 1000 per year to 0.45 per 1000 per year from 1997 to 2001. Male subjects had higher treated prevalence in younger age groups than did female subjects. Higher prevalence was associated with the 25–44 and 45–64 age groups, insurance amount less than US$640, the eastern region, and suburban areas. Lower incidence was associated with 45–64 age group. Higher incidence was associated with insurance amount less than US$640, and the eastern region. Conclusions: Because the prevalence rates of psychiatric disorders were generally lower in this study and in the 1985 community survey than those in other countries, it was concluded that both major and minor psychiatric disorders were undertreated in Taiwan. Persons with major psychiatric disorder have higher mental health care use and costs than those with minor psychiatric disorder. Persons with minor psychiatric disorder, or major psychiatric disorder without catastrophic illness registration also have higher non-mental health care use and costs than those without psychiatric disorder. We must emphasize the mental illness education, prevention, and treatment, and the general health care of persons with psychiatric disorders is also important. According to the trends of cumulative prevalence and incidence density, the treated prevalence and incidence rate of schizophrenia will be approximate to community rates gradually. Most persons with schizophrenia had received treatment in Taiwan after the NHI program was implemented. Future studies should focus on outcome and cost evaluation.