Kovess-Masfety V, Rabaté L, Caby D, Nicaise P
LPPS, Paris Cité University, Paris, France; Cour des comptes, Paris, France.
Cour des comptes, Paris, France.
Health Policy. 2023 Dec;138:104945. doi: 10.1016/j.healthpol.2023.104945. Epub 2023 Nov 14.
In France, spending on mental health and psychiatric care, in proportion to GDP, is close to the EU average. However, there are complaints that the French system is overwhelmed and potentially underfunded.
To describe the utilisation of psychiatric and mental health care in different settings to consider the appropriateness of care provision and resource allocation.
For the year 2018, several national databases on the use of all type of psychiatric care provision (full and part-time hospitalisations, private and public, public ambulatory care, private office-based psychiatrists) were cross-tabulated with diagnosis categories for different age groups and illness severity in order to assess the use of resources and evaluate the appropriateness of resource allocation.
A sizable proportion of patients with mild and moderate mental disorders are treated in psychiatric care whilst there is insufficient continuity of care for patients with severe disorders, who are not adequately followed up after discharge from hospitals. This contributes to increase the rate of re-hospitalisations, the use of emergency departments, and longer stays in hospitals.
The several components of the French mental health care system are used inappropriately, not only in geographical terms but also in terms of service use. We argue that strengthening the access to affordable psychotherapy and the implementation of a stepped-care approach could contribute to solve this issue.
在法国，心理健康和精神科护理方面的支出占国内生产总值的比例接近欧盟平均水平。然而，有人抱怨说法国的体系不堪重负且可能资金不足。
描述不同环境下精神科和心理健康护理的使用情况，以考量护理提供和资源分配的适当性。
针对2018年，将几个关于各类精神科护理提供使用情况（全日制和非全日制住院治疗、私立和公立、公共门诊护理、私立诊所精神科医生）的国家数据库与不同年龄组和疾病严重程度的诊断类别进行交叉列表分析，以评估资源使用情况并评价资源分配的适当性。
相当一部分轻度和中度精神障碍患者接受精神科护理治疗，而重度障碍患者的护理连续性不足，他们出院后没有得到充分的随访。这导致再住院率上升、急诊科使用率增加以及住院时间延长。
法国心理健康护理系统的几个组成部分使用不当，不仅在地域方面，而且在服务使用方面。我们认为加强获得负担得起的心理治疗的机会以及实施逐步护理方法有助于解决这一问题。
