School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China.
Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, China.
BMC Public Health. 2019 Jul 31;19(1):1023. doi: 10.1186/s12889-019-7343-7.
Reform of the health care system in China has prompted concerns about the utilization of mental health services. This study aims to compare the utilization of mental health services among inpatients in various types of health institutions in Shanghai (community health care centres, secondary general hospitals, tertiary general hospitals, and specialty hospitals).
Based on electronic health record (EHR) data, we extracted all of the mental hospitalization data from various types of public health institutions in Pudong New Area, Shanghai, China, from 2013 to 2016. The distribution of mentally ill inpatients and the possible factors contributing to the observed differences in these institutions were analysed.
Specialty psychiatric hospitals in Pudong New Area, Shanghai, admitted more inpatients and treated in patients with more severe disorders (49.73%). However, those who were male (OR = 0.545), were elderly (OR = 20.133), had inferior insurance (urban social insurance for citizens: OR = 4.013; paying themselves, OR = 29.489), had a longer length of stay (OR = 1.001) and had lower costs (OR = 0.910) were more likely to choose community health centres than specialty hospitals. Those who preferred the secondary and tertiary hospitals to the specialty ones were more likely to be in the male, elderly, married, shorter length of stay and higher-cost groups. Notably, compared to those with urban social insurance for workers, those who had urban social insurance for citizens (OR = 3.136) or paid out-of-pocket (OR = 9.822) were significantly clustered in the tertiary hospitals rather than the specialty hospitals.
Inpatients who were male, were older, had inferior insurance, had a longer length of stay and had lower costs preferred the elementary health services. However, the utilization of mental health care in high-tier institutions reflected defects, especially the fact that the current health insurance system does not adequately restrict patients' choices, and those who paid more tended to choose tertiary hospitals instead of professional specialty ones. We suggest that psychiatric services should be enhanced by instituting reforms, including public education, improved health insurance, a forceful referral system, and competency reinforcement for primary care physicians, to provide a more integrated mental health system.
中国医疗体制改革引发了人们对精神卫生服务利用情况的担忧。本研究旨在比较上海市不同类型医疗机构（社区卫生服务中心、二级综合医院、三级综合医院和专科医院）住院患者的精神卫生服务利用情况。
基于电子健康记录（EHR）数据，我们从中国上海市浦东新区的各类公立医疗机构中提取了 2013 年至 2016 年的所有精神科住院数据。分析了各医疗机构精神科住院患者的分布情况以及可能导致这些差异的因素。
上海市浦东新区的专科医院收治的住院患者更多，治疗的患者病情更严重（49.73%）。然而，男性（OR=0.545）、老年（OR=20.133）、较差的保险（城市居民社会保险：OR=4.013；自费：OR=29.489）、较长的住院时间（OR=1.001）和较低的费用（OR=0.910）的患者更倾向于选择社区卫生中心而不是专科医院。那些选择二级和三级医院而不是专科医院的患者，更可能是男性、老年、已婚、住院时间较短、费用较高的人群。值得注意的是，与参加城镇职工社会保险的患者相比，参加城市居民社会保险（OR=3.136）或自费（OR=9.822）的患者明显集中在三级医院，而不是专科医院。
男性、年龄较大、保险较差、住院时间较长且费用较低的住院患者更喜欢初级卫生服务。然而，高等级医疗机构的精神卫生服务利用情况反映出了缺陷，特别是当前的医疗保险制度并没有充分限制患者的选择，而且支付更多费用的患者往往选择三级医院而不是专业的专科医院。我们建议通过实施改革来加强精神卫生服务，包括开展公众教育、改善医疗保险、建立强制转诊制度以及加强基层医生的能力，以提供更综合的精神卫生服务体系。
