Am J Psychiatry 1997; 154:1228-1234
Copyright © 1997 by American Psychiatric Association
Economic reforms and the acute inpatient care of patients with schizophrenia: the Chinese experience
MR Phillips, SH Lu and RW Wang
Shashi Psychiatric Hospital, Jingsha, Hubei, People's Republic of China.
OBJECTIVE: This study compared insured and uninsured schizophrenic
inpatients in China and examined changes in the acute inpatient care of
schizophrenic patients during China's economic reform era. METHOD: Detailed
chart reviews of 50 randomly selected inpatients discharged from a hospital
in central China each year from 1984 through 1993 identified 321 patients
with schizophrenia. Demographic, insurance, treatment, and cost data of
these patients were collected from the charts. RESULTS: With logistic
regression models to control for confounding variables, the analyses showed
that the 129 insured patients were significantly more likely than the 192
uninsured patients to be urban residents, to be older, to have had 7 or
more years of schooling, and to have had more psychiatric hospitalizations;
moreover, their index admissions were longer and were more likely to
include use of traditional Chinese medications. The estimated 19% of
schizophrenic individuals in the community with health insurance receive
inpatient treatment 2.8 times more frequently than the 81% without
insurance. Compared to admissions in 1984-1988, admissions in 1989-1993
were significantly shorter and involved longer periods of polypharmacy with
multiple antipsychotic medications but included lower mean
chlorpromazine-equivalent doses of medication. The relative cost of
inpatient care for an acute episode of schizophrenia increased 3.5-fold
over the 10-year period, from 11% of mean annual household income in 1984
to 37% in 1993. CONCLUSIONS: Changes in the incentive system for care
providers and rapid increases in the cost of care during the economic
reform era have resulted in increasingly restricted availability of
services for the many schizophrenic patients without health insurance.
