CAJ | 학술논문

背景目前很少有关于精神疾病住院患者精神疾病和非精神疾病治疗费用的研究,而这方面的信息对规划精神卫生服务和医疗保险具有重要意义.目的对2010年浙江省精神病专科医院住院患者的住院费用进行评估.方法采用两阶段分层随机抽样方法从浙江省42家精神专科医院中抽出14家精神病院,再从抽出的各家医院中以月份为基本单位系统抽出2010年3个月(3、7、11月)的出院患者进行调查.编制<出院患者住院情况调查表>,收集患者的人口学特征、临床特征及多项住院费用信息.结果共调查住院患者7 684例.患者的平均住院时间(四分位数)为30 (20-52)d,平均总住院费用为10 005(6 419-14 728)元(1 539 US),平均药费为2 512(1 161-4 182)元,其中65%为非精神科药费,1 798(24.3%)例患者的入院时伴有需要治疗的一种或多种躯体疾病,包括高血压、白细胞减少、糖尿病和各种感染.患者的精神疾病诊断不同,其躯体疾病合并症不同.经过排除其他混杂因素后,共病躯体疾病患者的住院费用显著增加,但住院时间未增加.对于精神分裂症患者,精神科的药费显著高于非精神科药费,但其他精神疾病患者的花费情况与之相反.结论精神病院住院患者的费用中,躯体疾病的治疗费用占较大比例.在修订精神疾病的补偿措施、建立诊断相关的支付方案以及建立诊断特定的治疗指南时,都需要考虑到精神疾病伴发躯体疾病的高患病率和治疗费用,也需要确保精神科医生的在职培训能使他们及时了解常见躯体疾病的诊断和治疗的新进展.
배경목전흔소유관우정신질병주원환자정신질병화비정신질병치료비용적연구,이저방면적신식대규화정신위생복무화의료보험구유중요의의.목적대2010년절강성정신병전과의원주원환자적주원비용진행평고.방법채용량계단분층수궤추양방법종절강성42가정신전과의원중추출14가정신병원,재종추출적각가의원중이월빈위기본단위계통추출2010년3개월(3、7、11월)적출원환자진행조사.편제<출원환자주원정황조사표>,수집환자적인구학특정、림상특정급다항주원비용신식.결과공조사주원환자7 684례.환자적평균주원시간(사분위수)위30 (20-52)d,평균총주원비용위10 005(6 419-14 728)원(1 539 US),평균약비위2 512(1 161-4 182)원,기중65%위비정신과약비,1 798(24.3%)례환자적입원시반유수요치료적일충혹다충구체질병,포괄고혈압、백세포감소、당뇨병화각충감염.환자적정신질병진단불동,기구체질병합병증불동.경과배제기타혼잡인소후,공병구체질병환자적주원비용현저증가,단주원시간미증가.대우정신분렬증환자,정신과적약비현저고우비정신과약비,단기타정신질병환자적화비정황여지상반.결론정신병원주원환자적비용중,구체질병적치료비용점교대비례.재수정정신질병적보상조시、건립진단상관적지부방안이급건립진단특정적치료지남시,도수요고필도정신질병반발구체질병적고환병솔화치료비용,야수요학보정신과의생적재직배훈능사타문급시료해상견구체질병적진단화치료적신진전.
Background:Few studies in China assess the relative costs of treating psychiatric and non-psychiatric medical conditions among psychiatric patients.This information is important for the planning of mental health services and of health insurance packages. Objective:Assess the breakdown of the 2010 costs of psychiatric inpatient care in a representative sample of psychiatric hospitals in Zhejiang Province,China. Methods: A two-stage stratified sampling method was used to select 14 of the 42 psychiatric hospitals in Zhejiang and then discharges for three randomly selected months (March,July and November) in 2010 at these hospitals were selected for assessment.A standardized form was used to collect information about the demographic and clinical characteristics of the patient and about the various components of the costs of inpatient care. Results: 7,684 inpatient admissions were included.The median (interquartile range) length of stay was 30 (20-52) days and the median total cost of admission was 10,005 (6,419-14,728) Chinese Yuan (1,539 (S)US).The median cost of medication was 2,512 (1,161-4,182) Yuan,65% of which was for non-psychiatric medications.1,798 (24.3%) of the admissions were associated with one or more medical condition that required treatment,including hypertension,leucopenia,diabetes and different types of infections.The prevalence and type of medical condition varied significantly for patients with different classes of psychiatric diagnoses.After adjustment for other factors the presence of a co-morbid medical condition significantly increased the cost of hospitalization but not the duration of hospitalization.For inpatients with schizophrenia the cost of their psychiatric medications was significantly higher than the cost of their non-psychiatric medications but the opposite was true for patients with other diagnoses.Conclusion:Treatment of somatic conditions account for a high proportion of the cost of inpatient treatment in psychiatric hospitals.Plans to revise the reimbursement mechanisms for mental disorders,to develop diagnostic-related group payment schemes,and to establish diagnostic-specific treatment guidelines need to take into consideration the high prevalence and associated costs of treating somatic conditions that frequently accompany psychiatric illnesses.The in-service training of psychiatrists needs to ensure that they are up-to-date on recent advances in the diagnosis and treatment of common physical disorders.