686项目31个示范市(州)重性精神疾病患者经济水平及参保和治疗情况分析

目的 了解“686项目”地区重性精神疾病患者的经济、参保及治疗情况。方法 对“686项目”的31个示范市(州)采用自编调查问卷收集截至2012年末重性精神疾病患者的汇总统计数据, 分析总体情况并比较东部、中部、西部和东北四大地区患者的经济、参保、治疗情况差异。结果 重性精神疾病患者中家庭无收入者占13.02%, 有收入但收入在当地低保线以下者占33.25%, 低保线以上者占53.73%;城镇职工医疗保险占21.24%, 城镇居民医疗保险占21.73%, 新农合占45.40%, 无医保占11.63%;未治疗者占17.66%, 间断治疗者占45.17%, 连续治疗者占37.17%;东部、中部、西部和东北四大地区的患者经济、参保、治疗情况差异均有统计学意义(P<0.01), 东北地区患者经济情况最差, 且未治疗的患者比例最高为27.30%, 中部地区患者无医保比例最高为18.17%。结论 重性精神疾病患者总体经济水平较差, 医保覆盖率较全国人群低, 连续正规治疗患者比例低, 且患者的经济水平、参保及治疗情况在四大地区存在差异。

Economic condition,basic medical insurance and medication among patients with severe mental illness in 31 demonstration cities for686 programimplementation

Objective To investigate the economic condition,basic medical insurance and medication of the patients with severe mental illness in regions covered by a central government funded program for treatment and management of severe mental illness patients(“686 program”).Methods We used a unified self-designed questionnaire to collect information on patients with severe mental illness in 31 demonstration cities for “686 program” implementation from 2003 through 2012.Economic condition,basic medical insurance and treatment of the patients were described,and regional differences(eastern,central,western and northeast region)in the situations were also compared.Results Of the 322 783 patients covered by the program in 2012,13.02%had no income,33.25%had a lower income than local minimum living standard,and 53.73%had a higher income than local minimum living standard.There were 21.24%,21.73%,and 45.40%of the patients covered by the medical insurance for urban workers,medical insurance for urban residents,and new rural cooperative medical insurance,respectively,and the proportion of the patients without medical insurance was 11.63%.Only 37.17%of the patients had continuous medication,45.17%had intermittent medication,and 17.66%had no medication history at all.Significant regional differences in economic situation,medical insurance,and medication for the patients were observed among the 4 regions(P<0.01).The economic status of the patients in the Northeast China was the worst,with 64.36%of the patients having no income or the income below the minimum living standard,and a higher proportion(27.30%)of the patients receiving no medication than the other three regions;the highest proportion(18.17%)of the patients without medical insurance was observed in the Central China.Conclusion Generally speaking,patients with severe mental illness in 31 demonstration cities with the implementation of “686 program” have a poorer economic status and a lower coverage of medical insurance than the general population,and most of them have no regular medication,with obvious regional differences in the conditions.