Magnezi Racheli, Zrihen Ilan, Ashkenazi Isaac, Lubin Gad
Medical Services and Supply Center, Medical Corps, Israel Defense Forces, Israel.
Mil Med. 2007 Jul;172(7):686-9. doi: 10.7205/milmed.172.7.686.
Hospitalization costs are lower in psychiatric hospitals than in psychiatric departments of general hospitals. However, soldiers hospitalized in psychiatric hospitals are subject to the stigma associated with mental illness. The goal of this study was to examine the financial costs of preventing such stigma by hospitalizing soldiers in psychiatric departments of general hospitals, rather than less expensive psychiatric hospitals. Another goal was to find ways to reduce hospitalization costs, taking into consideration the consequences of the stigma for patients and their families. Costs, medical data, and demographic data were gathered from records of soldiers hospitalized for psychiatric illness. The most expensive causes of hospitalization were determined (acute psychotic state and adjustment disorders), and the characteristics of a soldier most likely to encounter psychosis were described. Recommendations include rerouting patients from hospitalization to ambulatory day care, when possible, and from general to psychiatric hospitals. We also recommend adopting a psychiatric diagnosis-related group price list to standardize sums paid per diagnosis and creating a system for considering, on a case-by-case basis, early discharge of soldiers with psychotic disorders during the stressful first half-year of military service.
精神病医院的住院费用低于综合医院的精神科。然而，在精神病医院住院的士兵会受到与精神疾病相关的污名化影响。本研究的目的是通过让士兵在综合医院的精神科住院，而非费用较低的精神病医院，来检验预防这种污名化的财务成本。另一个目的是在考虑污名化对患者及其家庭的影响的情况下，找到降低住院费用的方法。从因精神疾病住院的士兵记录中收集了费用、医疗数据和人口统计数据。确定了最昂贵的住院原因（急性精神病状态和适应障碍），并描述了最有可能患精神病的士兵特征。建议包括尽可能将患者从住院转为日间门诊护理，以及从综合医院转到精神病医院。我们还建议采用与精神科诊断相关的分组价格清单，以规范每个诊断的支付金额，并建立一个系统，逐案考虑在服役压力较大的上半年对患有精神障碍的士兵提前出院。
