Abstract
BackgroundHigh rates of involuntary hospitalization and long lengths of stay have been problematic in Korea. To address these problems, the Mental Health and Welfare Law was revised in 2016, mainly to protect patient rights by managing involuntary admissions. The aim of this study was to evaluate the impact of the revised Mental Health and Welfare Law on deinstitutionalization by using routinely collected data from hospital admissions and continuity of mental health service use after hospital discharge as proxy measures of deinstitutionalization.MethodsWe used monthly-aggregated claims-based data with a principal or secondary diagnosis of schizophrenia from 2012 to 2019, collected by the National Health Insurance Service. Outcome variables included rates of first admission; discharges; re-admissions within 7, 30, and 90 days; outpatient visits after discharge within 7 and 30 days; and continuity of visits, at least once a month for 6 months after discharge. Using interrupted time series analysis, we estimated the change in levels and trends of the rates after revision, controlling for baseline level and trend.ResultsThere was no significant change in first admission and discharge rates after the revision. Immediately after the revision, however, the rates of re-admission within 7 and 30 days dropped significantly, by 2.24% and 1.99%, respectively. The slopes of the re-admission rate decreased significantly, by 0.10% and 0.14%, respectively. The slopes of the re-admission rate within 90 days decreased (0.001%). The rates of outpatient visits within 7 and 30 days increased by 1.98% and 2.72%, respectively. The rate of continuous care showed an immediate 4.0% increase.ConclusionsThe revision had slight but significant effects on deinstitutionalization, especially decreasing short-term re-admission and increasing immediate outpatient service utilization.
Highlights
Over the past 2 decades, the mental health system in the Republic of Korea has gone through several legal amendments
The slopes of the monthly trends of re-admission within 7 and 30 days decreased by 0.10% and 0.14%, respectively (p < 0.001)
For the rate of re-admission within 90 days, a significant decrease was only found for the slope (0.001%) (p < 0.05)
Summary
Over the past 2 decades, the mental health system in the Republic of Korea (hereafter Korea) has gone through several legal amendments. Before the 1990s, people with mental illness were often neglected at prayer centers or nursing homes without proper treatment [1] Their human rights were often violated with oppressive. The average length of stay of psychiatric patients in Korea was the longest among OECD countries (233 days in 2008 and 116 days in 2011) [4, 5], marking Korea as a country with a high level of institutionalization [6]. High rates of involuntary hospitalization and long lengths of stay have been problematic in Korea. To address these problems, the Mental Health and Welfare Law was revised in 2016, mainly to protect patient rights by managing involuntary admissions. The aim of this study was to evaluate the impact of the revised Mental Health and Welfare Law on deinstitutionalization by using routinely collected data from hospital admissions and continuity of mental health service use after hospital discharge as proxy measures of deinstitutionalization
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