Psychiatric Rehabilitation Services, Department of Psychiatry, National Institute of Mental health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
Department of Psychiatric Social Work, Central Institute of Psychiatry (CIP), Ranchi, Jharkhand, India.
Asian J Psychiatr. 2019 Aug;44:138-142. doi: 10.1016/j.ajp.2019.07.029. Epub 2019 Jul 14.
In India, expenditure incurred to access mental health services often drives families to economic crisis. Families of Persons with mental illness (PMI) incur 'out-of-pocket' (OOP) expenditure for medicines, psychiatrist fee and travel in addition to losing wages on the day of visiting psychiatrist.
To describe impact of Community Based Rehabilitation (CBR) on OOP expenditure incurred by families of persons with severe mental illness (PSMI).
The sample comprised 95 PSMI who switched from treatment from other mental health facilities to CBR at Jagaluru, India.
The PSMI were predominantly male (52%) with mean age 41 years and diagnosed with psychosis (75%). Most of them (84%) were earlier taking treatment from private sector and spent on an average Rs. 15,074 (US $ 215) per PSMI per annum in availing treatment. After availing CBR, the annual expenditure reduced to Rs 492 (US $ 7) on an average per PSMI. OOP expenditure on medicines (largest head of expenditure) and psychiatrist consultation fee dropped to zero.
After excluding costs incurred to run the CBR, the net savings for the system for 95 PSMI included in study alone was Rs 3,83,755 (US $ 5,482) per annum. The amount would be much higher on including savings for PSMI initiated on treatment for the first time and PMI on regular follow-up in CBR.
Provision of CBR in partnership with public health system and NGO's leads to dramatic fall in OOP health expenditure of families of PSMI. It is also cost-effective to the system.
在印度，获得精神卫生服务的支出常常使家庭陷入经济危机。精神疾病患者（PMI）的家属除了在看精神病医生的当天损失工资外，还要支付药品、精神病医生费用和旅行的“自付”（OOP）费用。
描述社区为基础的康复（CBR）对严重精神疾病患者（PSMI）家属自付支出的影响。
该样本包括 95 名从印度 Jagaluru 的其他精神卫生机构转至 CBR 治疗的 PSMI。
PSMI 主要为男性（52%），平均年龄 41 岁，被诊断患有精神病（75%）。他们中的大多数（84%）之前在私营部门接受治疗，平均每年为每位 PSMI 支付 15074 卢比（215 美元）的费用。在获得 CBR 后，每位 PSMI 的年支出平均减少到 492 卢比（7 美元）。药品（最大的支出项目）和精神病医生咨询费的自付支出降至零。
在排除 CBR 运行成本后，仅纳入研究的 95 名 PSMI 的系统净节省额为每年 383755 卢比（5482 美元）。如果包括首次开始治疗的 PSMI 和 CBR 定期随访的 PMI 的节省额，金额将会更高。
与公共卫生系统和非政府组织合作提供 CBR 可显著降低 PSMI 家属的自付卫生支出。这对系统也是具有成本效益的。
