【全民健保增進精神照護可近性:思覺失調症需住院比率逐年下降】
臺大公衛學院研究報告指出,自建保實施以來,廣設精神科院所,增加了精神醫療的可近性,使思覺失調症(舊稱精神分裂症)患者首度發病而需住院的比例降低。
公衛學院院長陳為堅教授,與其指導學生江芝林醫師經由健保資料庫分析,1998年至2007年的10年之間,台灣思覺失調症的首次住院率從10萬分之35.6下降到10萬分之18.7,下降幅度高達48%。該成果榮獲刊登於《社會精神醫學及精神科流行病學》(Social Psychiatry and Psychiatric Epidemiology) 期刊。
公衛學院於3月2日召開研究發表會,由杜裕康教授主持,陳為堅院長引言,新光吳火獅紀念醫院精神科江芝林醫師報告研究成果,由健管所董鈺琪副教授、衛生福利部心理及口腔健康司諶立中司長、臺大精神醫學科胡海國名譽教授擔任評論。
精神病患 (包括疑似患者) 的醫療人權議題,近年來逐漸受到台灣社會的關注。現代精神醫療模式往往被政府及一般民眾賦予期待,能發揮社會安全網的角色,讓精神不穩定的患者能夠遠離社區;而人權團體則批評現代精神醫療模式中對於精神病患者的過度醫療化、過度限制人權的作法。這些爭議在去年的「政大搖搖哥」事件中,進一步浮上檯面而成為全國關注的議題。然而在爭議的過程中,精神病患或是現代精神醫療,似乎很難有一方能不被汙名化。而這樣的汙名化不但強化了社會對於精神疾病患者的集體恐懼與排斥,也導致精神病患者不願意接受治療。
公衛學院陳為堅院長,與其指導學生江芝林醫師,以健保資料庫進行研究,探討我國自健保實施以來,思覺失調症患者的首次住院發生率的歷年變遷。此研究結果榮獲刊登於《社會精神醫學及精神科流行病學》(Social Psychiatry and Psychiatric Epidemiology) 期刊。研究顯示,在健保實施以來的頭十年內 (1998年至2007年),台灣思覺失調症的首次住院率從十萬分之35.6下降至十萬分之18.7,下降幅度高達48%;所有精神病診斷的首次住院率則從十萬分之47.8下降至十萬分之29.2,下降幅度亦高達38%。住院率的逐年下降,表示因病情惡化而需要住院的思覺失調症患者的比例越來越低。這與健保實施後精神醫療可近性的增加、以及近年來相關精神科藥物治療的進展,有著十分密切的關係。
許多研究已經顯示,思覺失調症患者越早接受治療,越有機會恢復到生病前的功能水準。本研究則進一步從全國的角度顯示台灣近年來在思覺失調症治療所取得的成果。儘管治療永遠充滿挑戰,思覺失調症,以及其他的重大精神疾病,事實上是可以治療的。希望這樣的正向訊息,能夠讓精神疾病患者及家屬勇於就醫,也能夠讓社會大眾能更加理解精神疾病及其治療。
健保上路後,思覺失調症患者住院率為何大幅下降?江芝林醫師分析,這與健保實施後,廣設精神科院所有關,增加了精神醫療可近性,大部分患者在發病之初就有機會就醫,用藥治療。此外,新一代精神科藥物的副作用大幅降低,也提高了患者規則服藥的意願。
在記者會上,陳為堅教授補充表示,本研究的前3年間,病人自就診到住院的時間,中位數是為1.7年,但後3年間,中位數則延長至2.7年,顯示門診醫師越來越有能力延緩患者因病情惡化而需要住院的情形,反應出精神醫療的品質逐漸進步。
健康政策與管理研究所董鈺琪副教授提到,台灣醫療資源、科技進步,以及健保藥物給付都有改善,醫療供給也有增加,如精神專科醫師數從民國99年到2017年就成長了66%,基層診所的醫師成長更高,每年有8.2%成長。
衛生福利部心理及口腔司司長諶立中則表示,除了醫師人數的顯著成長以外,近二十年來醫院評鑑內容鼓勵各級醫院設立精神科,讓精神醫療不再侷限於精神科專科醫院及醫學中心,使得民眾就醫的可近性及意願均大幅提升。
精神健康基金會董事長、臺大醫學院精神醫學科名譽教授胡海國最後強調,近年來社會對精神健康知能提升很多,過去的患者可能都要經過求神問卜階段,現在都知道應該尋求專業治療。精神疾病如果早期發現、治療,療效最好,也可以降低日後可能惡化到需要住院的程度。所以民眾沒有必要諱疾忌醫,及早治療,療效更好。而社會大眾應多加理解精神疾病及其治療,不要用異象眼光看待精神疾病患者。
論文完整出處:
Chih-Lin Chiang, Pei-Chun Chen, Ling-Ya Huang, Po-Hsiu Kuo, Yu-Chi Tung, Chen-Chung Liu, and Wei J. Chen. Time trends in first admission rate for schizophrenia and other psychotic disorders in Taiwan, 1998-2007: a 10-year population-based cohort study. Social Psychiatry and Psychiatric Epidemiology. 2016 Dec 27. doi: 10.1007/s00127-016-1326-0
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tung chung population 在 本土研究社 Liber Research Community Facebook 的精選貼文
三跑規劃諮詢,城規會收到過12200份申述反對修訂,只有幾份支持,說明整個規劃有幾荒謬反智。
而家去到「就申述提交意見」的步驟(城規程序係咁),大家可於星期一晚前提交意見(要寫清楚就邊個申述提交意見)。所有提過申述同就申述提過意見的都有得上城規會直接講意見。
講公民規劃權,就要響呢啲程序上都不能放過。大家可參考「人人監機會」意見信,或自行到城規會網頁一覽各個申述摘要:
http://www.info.gov.hk/tpb/tc/plan_making/draft_plan.html
(可直接在以上網頁交意見,搵赤鱲角張圖)
城規會就三跑規劃進行公眾諮詢,在大家努力下第一輪諮詢有超過12,200份的反對申述,只有四份的支持申述。但程序尚未完成,第二次公眾諮詢即將結束,正反雙方要再就對方申述提出意見,切勿輕視每個程序,對手有機會反動員更多的支持意見,所以請花幾分鐘時間再發表意見,以下是人人監機會的範本,可供大家參考,電郵至 tpbpd@pland.gov.hk , 記住九月七日,即星期一晚上11時59分就會截止。
Please make your comment on Representations in respect of Draft Chek Lap Kok Outline Zoning Plan No.S/I-CLK/13 by sending your email to tpbpd@pland.gov.hk before 11:59PM 7th September, next Monday. Below we provide you with the sample letter, please select the points randomly.
Comment on Representations In Respect of Draft Chek Lap Kok Outline Zoning Plan No.S/I-CLK/13
赤鱲角分區計劃大綱圖S/I-CLK/13三跑規劃就申述提出意見
The following comments are made under Section 6A(1) of the Town Planning Ordinance (TPO) in respect of the representations.
以下意見是根據城規條例6A(1)而作出的:
Comment on Representations No. TPB/R/S/I-CLK/13-1 to 4
1. The representations support the 3R System (3RS) as Hong Kong needs the 3RS to sustain competitiveness and growth. The support has been made on the basis that the 3RS would achieve the target capacity as claimed by Airport Authority Hong Kong (AAHK). It must be pointed out that there is serious doubt that the 3RS would be able to achieve its target capacity as explained in Representation No. TPB/R/S/I-CLK/1-392 and many other representations. In this regard the support is not substantiated.
支持三跑系統的申述認為香港需要多一條跑道提升競爭力,這純粹建基於機管局單方面認為三跑系統可以達至預期容量。但我們必須指出,有很多的意見,包括TPB/R/S/I-CLK/1-392對機管局所作的預測有嚴重的質疑,所以支持者的意見並非建基於實質的理據。
2. The representations support the 3RS because of constraint of runway capacity and that the 3RS is required for Hong Kong’s medium to long-term demand and maintain competitiveness of HKIA from other airports in the region. There are other alternatives which may increase the runway capacity of the airport. The AAHK however has failed to explain to the general public what action or thorough studies they have undertaken to identify the most feasible one in terms of environmental, social as well as economic impact. And the process of how the 3RS becomes AAHK’s most favourable scheme and the criteria for which the alternatives were assessed have not been disclosed to the public. In other words the selection process has not been conducted in a transparent manner. It is thus very doubtful whether the 3RS is the most feasible option to address the problem of capacity constraint.
支持申述認為雙跑系統將近飽和,三跑可滿足香港中至長期的航運需求,有助維持區內競爭力。事實上,提升目前雙跑容量的方法未必只有一個,只是機管局一直拒絕公開當中的研究過程,從而達至一個最符合環保、社會及經濟效益的方案。機管局所推銷的三跑方案,是經過甚麼準則,如何篩選出來,公眾一無所知。換言之,這是一個黑箱作業的過程,根本無法解釋三跑的效益,因而引發外界的質疑。
3. Representation No. TPB/R/S/I-CLK/13-3 opine that the expanded airport combined with Tung Chung New Town Extension Development would be emerged for a new tourism hub for PRD region with retail and commercial facilities. The prime purpose of the HKIA, as stipulated in the Airport Authority Ordinance, shall, with the objective of maintaining Hong Kong’s status as a centre of international and regional aviation, provide, operate, develop and maintain an airport at and in the vicinity of Chek Lap Kok for civil aviation. The support is therefore based on wrong premise.
申述書TPB/R/S/I-CLK/13-3指出機場擴建是要結合東涌新市鎮發展配合相關的零售和商業配套成為新的旅遊樞鈕。而根據機管局條例,機場的核心業務並非如此,而是要保持香港作為國際和區域航空樞鈕的地位,由此可見,支持者的意見建基於錯誤的前提。
4. Representation No. TPB/R/S/I-CLK/13-3 also consider the EIA thorough and well-balanced and that the proposed marine park will ensure the prosperity of marine life. It was shown that after completion of infrastructure projects Chinese White Dolphin has been observed to repopulate the region soon after completion of works. Such support is stemmed from misunderstanding on the quality of the EIA report content, which has been challenged by many dolphin experts and environmentalists for its incompliance of the EIA Ordinance during the public inspection period. In fact, the decision to approve the EIA report by EPD is now subject of judicial review and is awaiting the ruling of the court. The challenge is based on the inadequacy of the EIA report to properly address the construction phase impact on the local dolphins, and ineffectiveness of proposed compensation measures with very little evidence the local dolphin population would recover from such massive habitat loss at the 3RS footprint. It is a consensus among the leading dolphin experts, environmentalists and ACE members that the proposed marine park to be established after the seven-year long construction would not be adequate to compensate for the habitat loss to the dolphins.
申述書中No. TPB/R/S/I-CLK/13-3認為,環評報告和建議的海岸公園已平衡了海洋生態的影響,中華白海豚會在工程完成後重新返回棲息地。有關的看法是源於對環評報告的錯誤理解,因為環評報告已被多名海洋生態學者和保育人士批評違反了環評條例,同時亦面對司法覆核的挑戰正等候法庭審訊。其中一個重要論點正是挑戰環評報告忽略補償於建造期間所造成的海洋生態影響,環評報告根本無法證明,所提的的措施可有效回復中華白海豚因三跑工程而失去的棲息地。
It is noticed that apart from Representations No. TPB/R/S/I-CLK/13-1 to 4 the remaining of the over 12,200 representations object to the 3RS on various reasons such as disturbance to villages and communities in the neighbourhood of the airport. The Board should give due consideration to these representations and AAHK should consider mitigation measures before the project should proceed further. The safety issues mentioned at, among others, Representations No. TPB/R/S/I-CLK/13-400 should be dealt with thoroughly and all relevant studies mentioned should be undertaken and considered by the Board. The reasons mentioned at all other representations should also be considered thoroughly by the Board otherwise should the 3RS materialize and fail to achieve its target capacity the Board and relevant Government departments will be held responsible.
超過12200份反對的申述中,其中包括對於鄰近居民及社區所造成的各種滋擾影響,委員會應給予適切的回應及機管局在工程進一步發展前考慮給予補償或減輕影響的措施。同時,申述書 No. TPB/R/S/I-CLK/13-400所提出的安全問題亦應徹底處理。委員會應認真處理所有意見書提出的理據,否則三跑落實後而又未能達至預測的效益,則城規會及相關政府部門要負上責任。
In view of the above it will be premature to proceed with the amendments to the Draft Plan further and that the Board should propose amendments to delete the amendments to the Draft Chek Lap Kok Outline Zoning Plan No.S/I-CLK/13.
基於以上的反對意見,圖則的修訂過早提出。城規應 刪除所有的修訂。