浙江省救助性精神障碍患者医疗成本分析

目的分析浙江省救助性精神障碍患者的医疗成本。方法收集2006—2009年间浙江省湖州市和绍兴市精神卫生中心的救助性精神障碍患者331例（两市分别123例和208例）,并以单纯随机的方式选择两地同时期住院的331例非救助性精神障碍患者为对照,分析救助性精神障碍患者的精神障碍类型和躯体状况,并比较救助性精神障碍患者和非救助精神障碍患者的日均医疗成本。结果在湖州市和绍兴市救助性精神障碍患者中疾病类型主要为精神分裂症（67.4%）,其次为精神发育迟滞或老年性痴呆（16.3%）和酒精所致精神障碍（9.1%）;其中38.9%的患者合并躯体疾病,主要为消化道疾病（24.5%）和呼吸道感染（16.9%）等。两地救助性精神障碍患者住院日均医疗成本均显著低于非救助性精神障碍患者（P〈0.05或P〈0.01）;有躯体合并症的救助性精神障碍患者的日均医疗成本显著高于无躯体合并症者（P〈0.01）;但地区间差异均无统计学意义（P〉0.05）。结论浙江省救助性精神障碍患者的医疗成本虽明显低于非救助性精神障碍患者,但仍相对较高;可通过缩短住院时间、建立基本药物和诊疗制度,以及定期免费投药和随访等方式,使患者在得到合理救助的同时,降低医疗成本。

Analysis of medical cost of patients with mental disorders under government assistance in Zhejiang Province

Objective To analyse the medical cost of patients with mental disorders under government assistance in Zhejiang Province. Methods Three hundred and thirty-one patients with mental disorders under government assistance were selected from Huzhou Mental Health Center(n=123) and Shaoxing Mental Health Centers (n=208) between 2006 to 2009, and another 331 patients with mental disorders without government assistance were also selected from Huzhou Mental Health Center (n=123) and Shaoxing Mental Health Centers (n=208) between 2006 to 2009. The categories of mental disorders and physical conditions of patients with mental disorders under government assistance were analysed, and daily medical cost was compared between patients with mental disorders under government assistance and those with mental disorders without government assistance. Results The main categories of mental disorders in patients with mental disorders under government assistance in Huzhou and Shaoxing were schizophrenia (67.4%), mental retardation and dementia (16.3%), and mental disorders due to use of alcohol (9.1%). Meanwhile, 38.9% of patients with mental disorders under government assistance suffered from physical diseases such as digestive tract diseases (24.5%) and respiratory tract infection (16.9%). Daily medical cost of patients with mental disorders under government assistance was significantly lower than that of patients with mental disorders without government assistance in Shaoxing (P<0.05), and the same condition was found in Huzhou (P<0.01). Daily medical cost of patients with mental disorders under government assistance complicated with physical diseases was significantly higher than that of patients with mental disorders under government assistance without physical diseases (P<0.01). However, there was no significant difference in daily medical cost between patients in Huzhou and those in Shaoxing (P>0.05). Conclusion Medical cost of patients with mental disorders under government assistance is much lower than that of patients with mental disorders without government assistance, but it is still relatively higher. Medical cost may be lowered with sufficient government assistance to those needed by reducing hospitalization duration, establishing basic system of medication and treatment, and conducting regular free drug administration and follow up.