Saxena Shekhar, Sharan Pratap, Saraceno Benedetto
Mental Health: Evidence and Research, Department of Mental Health and Substance Dependence, World Health Organization, CH - 1211, Geneva - 27, Switzerland.
J Ment Health Policy Econ. 2003 Sep;6(3):135-43.
Very little information is available on budget and financing of mental health services in the world.
During year 2001, WHO collected information from all countries on resources available for mental health care as a part of Project Atlas. The present report seeks to describe the situation regarding federal budgets and financing of mental health care at the country level. It also examines the association between relative allocation of health budget to mental health and mental health policy, programme and resource indicators in 89 countries.
The information was collected through a questionnaire (with an accompanying glossary) that was sent to the mental health focal point in the Ministry of Health of each country. Eighty nine countries provided information on their mental health budget as a proportion of health budget. In addition, information was obtained on policy, programme and mental health resource indicators (beds, personnel, services to special population and availability of drugs).
The results showed that 32% of 191 countries did not have a specified budget for mental health. Of the 89 countries that supplied the requisite information 36% spent less than 1% of their total health budget on mental health. Many countries from Africa (79%) and the South East Asia (63%) were in this subgroup. Comparison with the Global Burden of Disease data showed a marked disparity between burden and resources. Lower income countries allocated a lesser proportion of their health budget on mental health in comparison to higher income countries. The primary method of financing mental health care in most countries was tax-based (60.2%), but many low-income countries depended on out-of-pocket expenditure (16.4%). The presence of mental health policies and programmes in general was not associated with the proportion of health budget allocated to mental health. Counties categorized based on the proportion of mental health budget to health budget, differed significantly in terms of policy on disability benefits and mental health resource indicators (beds, personnel, services for special populations and availability of drugs).
Federal allocation for mental health care in most countries is low compared to the burden of these disorders. There is also a large disparity among countries and regions. Limitations of the study were, an exclusive reliance on government sources and the difficulty some governments faced in providing accurate information on federal mental health budget as it was not identified separately.
To use resources more efficiently and judiciously, countries should support integration of services, reallocation of mental health beds, training in mental health to providers and services for special populations.
Most countries need to increase their mental health budgets in order to provide necessary services. Countries with out-of-pocket payment as the primary method of mental health financing should seek to establish social insurance mechanisms.
More research needs to be conducted to gather specific information on mental health financing in relation to policy and service planning.
关于世界范围内精神卫生服务的预算和融资情况，可获取的信息非常少。
2001年，世界卫生组织从所有国家收集了有关精神卫生保健可用资源的信息，作为《世界精神卫生地图集》项目的一部分。本报告旨在描述国家层面精神卫生保健的联邦预算和融资情况。它还考察了89个国家卫生预算中精神卫生的相对分配与精神卫生政策、项目及资源指标之间的关联。
通过一份问卷（附带术语表）收集信息，问卷发送给每个国家卫生部的精神卫生联络点。89个国家提供了其精神卫生预算占卫生预算比例的信息。此外，还获取了政策、项目及精神卫生资源指标（床位、人员、针对特殊人群的服务以及药品供应情况）的信息。
结果显示，191个国家中有32%没有为精神卫生设立特定预算。在提供所需信息的89个国家中，36%用于精神卫生的支出占其卫生预算总额不到1%。许多非洲国家（79%）和东南亚国家（63%）属于这一类别。与全球疾病负担数据的比较显示，负担与资源之间存在明显差距。与高收入国家相比，低收入国家在精神卫生方面分配的卫生预算比例较低。大多数国家精神卫生保健的主要融资方式是基于税收（60.2%），但许多低收入国家依赖自费支出（16.4%）。总体而言，精神卫生政策和项目的存在与分配给精神卫生的卫生预算比例无关。根据精神卫生预算占卫生预算的比例进行分类的国家，在残疾福利政策和精神卫生资源指标（床位、人员、针对特殊人群的服务以及药品供应情况）方面存在显著差异。
与这些疾病的负担相比，大多数国家对精神卫生保健的联邦拨款较低。国家和地区之间也存在很大差距。该研究的局限性在于，完全依赖政府来源，并且一些政府在提供关于联邦精神卫生预算的准确信息时面临困难，因为该预算未单独列出。
为了更有效和明智地利用资源，各国应支持服务整合、重新分配精神卫生床位、对提供者进行精神卫生培训以及为特殊人群提供服务。
大多数国家需要增加其精神卫生预算，以便提供必要的服务。以自费支付作为精神卫生主要融资方式的国家应寻求建立社会保险机制。
需要开展更多研究，以收集与政策和服务规划相关的精神卫生融资的具体信息。
