目的:
　　本研究欲討論有失眠與沒有失眠的病人於醫療資源利用結果間關係，藉以了解病人其醫療資源利用情形與照護結果上的影響。
方法：
　　本研究為回溯性研究，以國家衛生研究院所提供之全民健保資料庫進行次級資料分析，樣本選取則是根據ICD-9-CM的失眠診斷編碼為主，為了減少分組後樣本間的差異，採用傾向分數配對法(Propensity Score Matching)以1：１的比例，在控制性別、年齡、共病症權重指數的情況下，將新發診斷為失眠的患者設定為個案組，無失眠者歸為對照組。以描述性統計、卡方檢定、t檢定、線性複迴歸、邏輯斯迴歸等方法分析與討論兩組樣本對醫療資源利用與照護結果間的影響。
結果：
　　研究結果發現，失眠病人主要以女性居多，年齡層以45-64歲占多數，共病症權重指數則是0分為主，醫療資源利用情形方面，不論是門診次數或是急診次數，失眠病人比率都較高，且達統計上顯著差義（p＜0.05），此外，失眠病人之照護結果也較差，藉由邏輯斯迴歸結果發現，失眠病人看精神科之風險值為（OR=5.56；95%CI=4.57-6.75）、因失眠看急診之風險值為（OR=73.42；95%CI=10.20-528.58）、因任何原因看急診之風險值為（OR=1.61；95%CI=1.52-1.70），均達統計上顯著意義（p＜0.05）。
結論：
　　本研究結果顯示，失眠病人確實有較高的醫療資源利用率，且後續的照護結果表現較差，若能夠減少失眠的罹患率，相對的可以降低醫療資源耗用及減少不必要的成本浪費，進而提高醫療品質。

Objective:
　　This research were to discuss the relationship between the outcome of health care utilization in medical car and patients with or without insomnia. In order to analyze the influence of health care utilization and medical care outcome from insomniac.
Method:
　　This research is a retrospective secondary analysis, mainly use the data from the National Health Insurance Database. To reduce the difference of each separate group, choose the Propensity Score Match as a main method. Then, control the gender , age and Charlson Comorbidity Index score based on the 1:1 proportion to set the newly diagnosis insomniac as a case group, and recipients without insomnia as a control group for discussing the impact of health care utilization and medical care outcome between case and control group by analyzing the statistics of t test, chi-square test and regression test.
Result:
　　This study results showed that high prevalence insomniacs are female adults, whose ages are between 45–64, and have higher clinic visit rate and emergency rate. In Charles Comorbidity Index, their score are basically 0. In addition, the research results revealed that the risk of patients visiting Psychiatric due to insomnia is (OR=5.56); the risk of visiting emergency in reason of insomnia is (OR=73.42), and the rate of visiting emergency in any reason is (OR=1.61).
Conclusion:
　　Patients with insomnia actually have higher utilization rate of health care and lower quality of medical care outcome.

口試委員會論文審定書.................................................................................................i
誌謝................................................................................................................................ii
摘要...............................................................................................................................iii
Abstract.........................................................................................................................iv
目錄................................................................................................................................v
圖次..............................................................................................................................vii
表次..............................................................................................................................vii
第一章 緒論..................................................................................................................1
　　第一節 研究背景與動機......................................................................................1
　　第二節 研究目的..................................................................................................3
第二章 文獻探討..........................................................................................................4
　　第一節 失眠之介紹..............................................................................................4
　　第二節 失眠於醫療照護之影響..........................................................................7
第三章 研究方法........................................................................................................12
　　第一節 研究設計與架構....................................................................................12
　　第二節 研究問題與假設....................................................................................14
　　第三節 研究樣本與資料來源............................................................................14
　　第四節 研究變項之操作型定義........................................................................17
　　第五節 統計分析................................................................................................20
第四章 研究分析與結果............................................................................................21
　　第一節 研究樣本人口學特質基本資料分析與就醫之醫療機構特性分佈之描
述性統計................................................................................................21
　　第二節 人口學特質在研究組別間對醫療資源利用情形之檢定分析............29
　　第三節 就醫之醫療機構特性在兩組研究樣本間對醫療資源利用情形之檢定
分析........................................................................................................32
　　第四節 各變項對醫療資源利用及醫療照護結果所產生的影響之檢定分
析............................................................................................................36
　　第五節 假設驗證................................................................................................48
第五章 討論................................................................................................................49
　　第一節 失眠的分佈情形....................................................................................49
　　第二節 醫療資源利用情形................................................................................50
　　第三節 醫療照護結果........................................................................................51
第六章 結論與建議....................................................................................................53
　　第一節 結論........................................................................................................53
　　第二節 研究限制................................................................................................54
　　第三節 研究建議................................................................................................55
　　第四節 研究貢獻................................................................................................56
參考文獻......................................................................................................................57

一、中文文獻
台灣睡眠醫學學會(2015)。睡眠321。2015年4月6日，取自http://sleep321.com.tw/

台灣睡眠醫學學會(2015)。睡眠新之。2015年4月6日，取自http://www.tssm.org.tw/knowledge.php

新光吳火獅紀念醫院睡眠中心(2015)。睡眠保健區－越「安眠」，越「失眠」？淺談失眠與助眠藥物。2015年4月6日，取自http://www.sleepcenter.com.tw/newsSystem/newshow.asp?news_id=89

台灣精神醫學會(2015)。官方公告－Schizophrenia中文譯名由「精神分裂症」更名為「思覺失調症」的歷史軌跡。2015年8月5日，取自http://www.sop.org.tw/Official/official_15.asp

劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義(2006)。台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究。健康管理學刊，4(1)，1-22。

張羃.(2014).台灣地區睡眠障礙患者之中西醫療服務利用與費用.亞洲大學健康產業管理學系長期照護組碩士論文，台中市。

張文蓓、林佳靜(2010)。失眠之概念分析。新台北護理期刊，12(1)，63-70。

呂萬安(2009)。失眠的預防與治療。中醫藥研究論叢，12，61-72。

朱哲生、陸悌(2011)。失眠之最新概況。台灣醫界，54(6)，310-316。
周桂如、蔡佩珊、林佳靜、孫嘉玲(2008)。失眠之概念分析。護理雜誌，55(5)，79-84。　

開詩婷(2012)。為什麼睡不著？失眠疾病敘事裡的病痛意義。暨南大學人類學研究所學位論文，南投縣。

莊慧馨、邱南英、胡淑惠（2004)。精神科門診初診主訴失眠患者的診斷分析。The Changhua Journal of Medicine，9(S)，254-260。

二、英文文獻
Anderson, L. H., Whitebird, R. R., Schultz, J., McEvoy, C. E., Kreitzer, M. J., & Gross, C. R. (2014). Healthcare utilization and costs in persons with insomnia in a managed care population. The American journal of managed care, 20(5), 157-165.

Bin, Y. S., Marshall, N. S., & Glozier, N. (2012). The burden of insomnia on individual function and healthcare consumption in Australia. Australian and New Zealand journal of public health, 36(5), 462-468.

Charlson Comorbidity Index. Retrieved from http://www.fpnotebook.com/prevent/Exam/ChrlsnCmrbdtyIndx.htm

Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45(6), 613-619.

Hsu, Y. W., Ho, C. H., Wang, J. J., Hsieh, K. Y., Weng, S. F., & Wu, M. P. (2013). Longitudinal trends of the healthcare-seeking prevalence and incidence of insomnia in Taiwan: An 8-year nationally representative study. Sleep medicine, 14(9), 843-849.

Hatoum, H. T., Kong, S. X., Kania, C. M., Wong, J. M., & Mendelson, W. B. (1998). Insomnia, health-related quality of life and healthcare resource consumption. Pharmacoeconomics, 14(6), 629-637.

Kaufmann, C. N., Canham, S. L., Mojtabai, R., Gum, A. M., Dautovich, N. D., Kohn, R., & Spira, A. P. (2013). Insomnia and health services utilization in middle-aged and older adults: results from the Health and Retirement Study.The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 68(12),1512–1517.

Léger, D., Guilleminault, C., Bader, G., Lévy, E., & Paillard, M. (2002). Medical and socio-professional impact of insomnia. Sleep, 25(6), 625-629.

Novak, M., Mucsi, I., Shapiro, C. M., Rethelyi, J., & Kopp, M. S. (2004). Increased utilization of health services by insomniacs—an epidemiological perspective. Journal of psychosomatic research, 56(5), 527-536.

Ozminkowski, R. J., Wang, S., & Walsh, J. K. (2007). The direct and indirect costs of untreated insomnia in adults in the United States. Sleep-New York Then Westchester-, 30(3), 263.

Pollack, M., Seal, B., Joish, V. N., & Cziraky, M. J. (2009). Insomnia-related comorbidities and economic costs among a commercially insured population in the United States. Current medical research and opinion, 25(8), 1901-1911.

Rosekind, M. R., & Gregory, K. B. (2010). Insomnia risks and costs: health, safety, and quality of life. The American journal of managed care, 16(8), 617-626.


Roy Anuja N, Smith Michael.(2010) Prevalence and cost of insomnia in a state Medicaid fee-for-service population based on diagnostic codes and prescription utilization. Sleep Medicine,11(2010),462-469.

Roth, T. (2007).Insomnia: Definition, Prevalence, Etiology, and Consequences. Journal of Clinical Sleep Medicine,3(5),S7-S10.

Shahly, V., Berglund, P. A., Coulouvrat, C., Fitzgerald, T., Hajak, G., Roth, T., ... & Kessler, R. C. (2012). The associations of insomnia with costly workplace accidents and errors: results from the America Insomnia Survey. Archives of general psychiatry, 69(10), 1054-1063.