浙江省精神病专科医院住院患者治疗费用调查

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7684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10005（6419．14728）元（1539美元），平均药费为2512（1161—4182）元，其中65％为非精神科药费，1798（24．3％）例患者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。

Cost of treating medical conditions in psychiatric inpatients in Zhejiang,China

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 2020 at these hospitals were selected for assessment. A standardized form was used to collect information about the demographic and clinical characteristics of the patients 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 （6,429-14,728） Chinese Yuan （1,539 SUS）. The median cost of medication was 2,522 （2,261-4,282） Yuan, 65% of which was for non-psychiatric medications. 1,798 （24.3%） of the admissions had one or more co-morbid 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. And 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.