Help-Seeking Behavior of Patients with Schizophrenia in Health Services Utilization

[[abstract]]Abstract The objective of the present research is to investigate the factors related to help-seeking behaviors in the patients with schizophrenia. Additionally, we try to treat of the help-seeking behavior effects the medical utilizations. We expect the results from the analysis of help-seeking behaviors of patient with schizophrenia could be the reference material for the design of payment system. Samples of the patients with schizophrenia in our investigation were adopted from the National Health Insurance registry for beneficiaries claims data files in 2000 which charged with National Health Research institution. The cases that were under 18-year-old and who have been the hospitalized patients before 2000 were excluded from the analysis. Medical information came from 620 patients with schizophrenia during 2000 and 2004 were involved, finally. Based on Andersen?s ?behavior model of health services use model?, through three dimensions, predisposing, reinforcing, enabling factors, and the characteristics of the healthcare organizations, we tried to examine the related factors to the help-seeking behaviors of patient with schizophrenia, and tried to analyze how the medical utilizations influenced by schizophrenic patients? help-seeking behaviors, at the same time. We found that there were 30%, nearly, of the patient with schizophrenia who went to seek the same doctor. There were around 70% of the patient with schizophrenia who went to the same healthcare organization, around 50% of the patient with schizophrenia who were not the cross-region visiting, and more than 80% of the patients who tried to seek the psychiatric services. Age, insured category and characteristics of the healthcare organization affected the help-seeking behaviors of patients with schizophrenia. The utilization rates of the patients related with the outpatient services, emergency treatment, and the hospitalization in schizophrenia were decreasing year by year, but there wasn?t much difference between the frequencies of each year, besides, the expenditures on outpatient services and hospitalization were increasing during the observed years. The outpatient utilization rates decreased from 92%to 68%, and the average frequency was 11-13 times. The hospitalized utilization rates were decreasing from 14% in 2000 to 9% in 2004, and the average frequency was 1.5 times in each year. The utilization rates in various psychosocial therapies were rising generally from 7.1% to 18.7%, and the utilization in psychotherapy was ranged 14% to 18.7%, which was prominently higher those in the others. The frequencies between the psychosocial therapies were less consistent; those were raged around 2.5 to 20.4 times. The utilization rate in community rehabilitation, by the way, was about 7.4% to 10.3%. Whether any expenditure in treatment items among the subjects were increasing, especially in the forth observed year. Furthermore, there wasn?t much variation in the subjects? utilization rates and frequencies that irrelevant to schizophrenia during the observed period. According to the results in our analysis, not only the medical utilization but also the expenditure was effected by the help-seeking behaviors. The patients sought medical services without cause of schizophrenia had higher outpatient frequencies and expenditures on the services which weren?t in connection with schizophrenia. Patient with schizophrenia who went to the same healthcare organization had lower outpatient, hospitalized and vocational therapy frequencies. Patients who sought psychiatric had lower behavioral therapy frequencies. In our investigation, the help-seeking behaviors of patients with schizophrenia were different from those of the common populations, and which also contributed the important influence upon medical utilizations and expenditures. Overall, patients with schizophrenia tend to have positive help-seeking behaviors; such phenomenon will be helpful for the implement of pay for quality payment system to the patient with schizophrenia in the future. The healthcare administrations should encourage patients to have positive help-seeking behaviors, in order to ensure that patients could receive the treatment, rehabilitation that will be more integrated and better with highly healthcare qualities