Department of Health Policy and Management, Seoul National University College of Medicine, 103 Daehangno, Jongno-gu, Seoul 03080, Republic of Korea.
Asian J Psychiatr. 2022 Feb;68:102934. doi: 10.1016/j.ajp.2021.102934. Epub 2021 Nov 24.
This study was performed to examine the changes in psychiatric hospitalization in Korea after the mental health law revision of 2017 with consideration of the COVID-19 pandemic.
The data were obtained from National Health Insurance and Medical Aid statistical yearbooks of 2011-2020. The changes in the inpatient and outpatient utilization for schizophrenia from 2011 to 2020 were compared with those for other psychiatric disorders and the general population. With difference-in-differences analysis, the changes in utilization of inpatient and outpatient care for schizophrenia after the law revision of 2017 were analyzed with two comparison groups.
While the number of inpatients and inpatient days for schizophrenia decreased between 2017 and 2019, the number of outpatients and outpatient visits for schizophrenia increased during the period. Inpatient care utilization in two comparison groups increased during the same period. Whereas the COVID-19 pandemic of 2020 led to a general decrease in health care use among the population including inpatient care for schizophrenia, the number of outpatients for schizophrenia increased slightly after the pandemic. Difference-in-differences analysis showed that the law revision was associated with the decrease in the use of inpatient care for schizophrenia after adjustment for the effect of the COVID-19 pandemic.
The mental health law revision in Korea led to a significant decrease in hospitalization for schizophrenia. However, the limited effect of revision on the Medical Aid beneficiaries suggests that the revision was not followed by the provision of the proper alternatives which can replace hospitalization of the most vulnerable population.
本研究旨在考察 2017 年精神卫生法修订后韩国精神病住院治疗的变化，并考虑到 COVID-19 大流行的影响。
数据来自 2011-2020 年国家健康保险和医疗援助统计年鉴。比较了 2011 年至 2020 年精神分裂症住院和门诊利用的变化，并与其他精神障碍和一般人群进行了比较。采用双重差分分析，对 2017 年精神卫生法修订后精神分裂症住院和门诊利用的变化，用两个对照组进行分析。
2017 年至 2019 年，精神分裂症住院人数和住院天数减少，但同期精神分裂症门诊人数和门诊就诊次数增加。同期两个对照组的住院治疗利用率增加。尽管 2020 年 COVID-19 大流行导致包括精神分裂症住院治疗在内的人群医疗保健利用普遍减少，但 COVID-19 大流行后，精神分裂症门诊就诊人数略有增加。双重差分分析显示，调整 COVID-19 大流行的影响后，法律修订与精神分裂症住院治疗利用减少有关。
韩国精神卫生法修订导致精神分裂症住院治疗显著减少。然而，修订对医疗援助受益人的影响有限，这表明修订后没有提供适当的替代方案来取代最弱势群体的住院治疗。
