Abstract
BackgroundReform 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).MethodsBased 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.ResultsSpecialty 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.ConclusionsInpatients 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.
Highlights
Reform of the health care system in China has prompted concerns about the utilization of mental health services
To fill the gap in the literature regarding the status of the utilization of mental health services in various health care institutions and its influencing factors under the current health care system, we focused on inpatient services, which are currently the target of reform for improving mental health services
Comparison of inpatients’ utilization of mental health services across various types of health care institutions A total of 7,910 hospitalizations of mental inpatients from 50 public health institutions in Pudong New Area during 2013–2016 were included, which were distributed across the four types of public institutions
Summary
Reform of the health care system in China has prompted concerns about the utilization of mental health services. The analysis revealed that China accounted for the highest disease burden (17%) of global mental, neurological, and substance use disorders, with depressive disorders and anxiety disorders being the most common [2]. According to a study by Xu (2016), the total costs of mental disorders in 2013 accounted for more than 15% of the total health expenditure in China [4]. Statistics from the WHO World Mental Health Survey (WMHS) showed that in the 26 countries participating in the survey, 35.50–50.30% of patients in developed countries did not seek treatment, while the percentages were between 76.30 and 85.40% in the participating developing countries. According to statistical data from the Ministry of Health, the incidence of mental health disorders increased significantly from 1993 to 2013, the treatment rate showed a reverse trend [9]. A study based on a sample from the eastern and western regions of China in 2009 showed that the treatment rate was lower than 10%, and in the western province of Qinghai, it was only 2% [10]
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