Peking University, Beijing, China.
The University of Nottingham, Ningbo, China.
Inquiry. 2020 Jan-Dec;57:46958020950566. doi: 10.1177/0046958020950566.
A common challenge faced by the healthcare systems in many low- and middle-income countries is the substantial unmet mental healthcare needs, or the large gap between the need for and the provision of mental healthcare treatment. This paper investigates the potential causes of this treatment gap from the perspective of economics. Specifically, we hypothesize that people with mental illness face major hurdles in obtaining appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to mental health, the high time costs due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We use China as a study setting to show country-specific evidence. Our analysis supports the above theoretical argument on the 4 barriers to access, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies.
许多中低收入国家的医疗体系面临的一个共同挑战是大量未满足的精神卫生保健需求，或精神卫生保健需求与提供之间存在巨大差距。本文从经济学的角度探讨了造成这种治疗差距的潜在原因。具体来说，我们假设患有精神疾病的人在获得适当的医疗保健方面面临重大障碍，即由于污名而导致的非货币成本高、由于用于精神卫生的公共资金不足而导致的自付费用高、由于精神卫生保健资源可获得性低而导致的时间成本高，以及由于技术传播缓慢而导致的治疗效果低。我们使用中国作为研究环境来展示具体国家的证据。我们的分析支持了关于 4 个准入障碍的上述理论论点，这反过来又为减轻治疗差距提供了有效的方法。然后讨论了四种政策选择，包括心理健康意识宣传运动、增加对初级精神卫生保健资源的公共投资、将医疗体系向以患者为中心的综合体系转变以及利用电子卫生技术。
