Disparities in mental health care utilization among inpatients in various types of health institutions: a cross-sectional study based on EHR data in Shanghai, China.
机构：[1]School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China[2]Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China[3]Pudong Weifang Community Health Center, Shanghai 200120, China[4]Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China[5]Department of Medical Informatics, Evidence-based Medical Center, Medical School of Nantong University, Nantong 226001, China[6]Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China[7]School of Public Health, Fudan University, Shanghai 200032, China[8]School of Medicine, Tongji University, Shanghai 200092, China[9]School of Economics and Management, Tongji University, Shanghai 200092, China[10]General Practice Center, Nanhai Hospital, Southern Medical University, 227 Chongqing South RD, Shanghai 200025, 528244, Guangdong, China.
Reform of the health care system in China has prompted concerns about the utilization of mental health services. This study aims to compare the utilization of mental health services among inpatients in various types of health institutions in Shanghai (community health care centres, secondary general hospitals, tertiary general hospitals, and specialty hospitals).
Based on electronic health record (EHR) data, we extracted all of the mental hospitalization data from various types of public health institutions in Pudong New Area, Shanghai, China, from 2013 to 2016. The distribution of mentally ill inpatients and the possible factors contributing to the observed differences in these institutions were analysed.
Specialty psychiatric hospitals in Pudong New Area, Shanghai, admitted more inpatients and treated in patients with more severe disorders (49.73%). However, those who were male (OR = 0.545), were elderly (OR = 20.133), had inferior insurance (urban social insurance for citizens: OR = 4.013; paying themselves, OR = 29.489), had a longer length of stay (OR = 1.001) and had lower costs (OR = 0.910) were more likely to choose community health centres than specialty hospitals. Those who preferred the secondary and tertiary hospitals to the specialty ones were more likely to be in the male, elderly, married, shorter length of stay and higher-cost groups. Notably, compared to those with urban social insurance for workers, those who had urban social insurance for citizens (OR = 3.136) or paid out-of-pocket (OR = 9.822) were significantly clustered in the tertiary hospitals rather than the specialty hospitals.
Inpatients who were male, were older, had inferior insurance, had a longer length of stay and had lower costs preferred the elementary health services. However, the utilization of mental health care in high-tier institutions reflected defects, especially the fact that the current health insurance system does not adequately restrict patients' choices, and those who paid more tended to choose tertiary hospitals instead of professional specialty ones. We suggest that psychiatric services should be enhanced by instituting reforms, including public education, improved health insurance, a forceful referral system, and competency reinforcement for primary care physicians, to provide a more integrated mental health system.
基金：
The design of this study, involving some previous investigations, was
supported by the Natural Science Foundation of China (71603182). Data
extraction was financially funded by the Natural Science Foundation of China
(71774116). The analysis and interpretation of the data guided by the
statisticians were funded by the Shanghai Health Policy Program (2018HP52),
and the writing and revision, including the language improvement, were
supported by the Shanghai Health Policy Program (2016HP043) and
Shanghai Excellent Young Talents Project in Health System (2018YQ52).
语种：
外文
PubmedID：
中科院(CAS)分区：
出版当年[2018]版：
大类|3 区医学
小类|3 区公共卫生、环境卫生与职业卫生
最新[2025]版：
大类|2 区医学
小类|2 区公共卫生、环境卫生与职业卫生
第一作者：
第一作者机构：[1]School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China[2]Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
共同第一作者：
通讯作者：
通讯机构：[1]School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China[10]General Practice Center, Nanhai Hospital, Southern Medical University, 227 Chongqing South RD, Shanghai 200025, 528244, Guangdong, China.
推荐引用方式(GB/T 7714)：
Shi Jianwei,Tang Lan,Jing Limei,et al.Disparities in mental health care utilization among inpatients in various types of health institutions: a cross-sectional study based on EHR data in Shanghai, China.[J].BMC public health.2019,19(1):1023.doi:10.1186/s12889-019-7343-7.
APA：
Shi Jianwei,Tang Lan,Jing Limei,Geng Jinsong,Liu Rui...&Wang Zhaoxin.(2019).Disparities in mental health care utilization among inpatients in various types of health institutions: a cross-sectional study based on EHR data in Shanghai, China..BMC public health,19,(1)
MLA：
Shi Jianwei,et al."Disparities in mental health care utilization among inpatients in various types of health institutions: a cross-sectional study based on EHR data in Shanghai, China.".BMC public health 19..1(2019):1023
