Abstract
Objective: Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China’s on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China. Methods: This retrospective study used 10 years (2005–2014) of hospital electronic health records (EHRs) from the Shandong Center for Mental Health (SCMH) and the DaiZhuang Psychiatric Hospital (DZPH), two major psychiatric hospitals in Shandong Province. Health insurance was measured using types of health insurance and the actual reimbursement ratio (RR). Utilization of mental health inpatient services was measured by hospitalization cost, length of stay (LOS), and frequency of hospitalization. We examined rural-urban disparities in the use of mental health services, as well as the role of health insurance in reducing such disparities. Results: Hospitalization costs, LOS, and frequency of hospitalization were all found to be lower among rural than among urban inpatients. Having health insurance and benefiting from a relatively high RR were found to be significantly associated with a greater utilization of inpatient services, among both urban and rural residents. In addition, an increase in the RR was found to be significantly associated with an increase in the use of mental health services among rural patients. Conclusion: Consistent with the existing literature, our study suggests that increasing insurance schemes’ reimbursement levels could lead to substantial increases in the use of mental health inpatient services among rural patients, and a reduction in 3 rural-urban disparities in service utilization. In order to promote mental health care and reduce rural-urban disparities in its utilization in China, improving rural health insurance coverage (e.g., reducing the coinsurance rate) would be a powerful policy instrument.
Highlights
Mental health has become an increasingly significant public health concern worldwide
There is a broad similarity in the challenges faced by mental health care practitioners across various countries (WHO 2001), primarily because mental health care services are rarely covered by health insurance packages and health plans to the same degree as are physical health care services, especially in low- and middle-income countries (Kellermann 2002; Rowan et al 2013)
It is likely that many patients in our sample were seeking mental health care outside of their cities/towns of residence, and their treatment was not covered by insurance
Summary
Mental health has become an increasingly significant public health concern worldwide. A study in the United States found that a median delay of years after the onset of mental illness and before a patient’s first contact with a general practitioner and years before a first contact with a psychiatrist (Wang et al 2004). This delay in treatment can lead to increased morbidity and mortality, including the development of various psychiatric and physical comorbidities and the adoption of life-threatening and life-altering self-treatments (e.g., licit and illicit substance abuse) (Wang et al 2007a, b). Are more mental health services excluded from insurance coverage, but the eligible mental health services are often subject to higher co-pays and are capped at a maximum number of covered treatments (Sturm 2000)
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