成都市严重精神障碍患者阳光救助数量和费用的时空差异分析  

Spatial and Temporal Distribution of Burden and Expenses of Patients with Severe Mental Disorder under Sunshine Assistance Policy in Chengdu

作　　者：齐亚娜 卢敏 张伟[1,3] 杨晓妍[1] 王威 李红娟 胡耀[1] 曾筱茜[1] 王军[1] QI Yana;LU Min;YANG Xiaoyan(West China Biomedical Big Data Center,West China Hospital,Sichuan University,Chengdu,610041,China)

机构地区：[1]四川大学华西医院华西生物医学大数据中心,四川成都610041 [2]成都市第四人民医院/成都市精神卫生中心,四川成都610036 [3]四川大学华西医院心理卫生中心,四川成都610041

出　　处：《中国社会医学杂志》2019年第4期421-425,共5页Chinese Journal of Social Medicine

基　　金：成都市严重精神障碍患者阳光救助实施效果研究项目(HX-H1711149);四川省卫生和计划生育委员会项目(18ZD044);四川省科技支撑计划项目(2016SZ0072)

摘　　要：目的了解成都市严重精神障碍患者阳光救助数量及补偿费用的时间和地区分布,为救助政策评估及完善提供依据。方法 收集成都市13家定点医院阳光救助精神障碍患者的住院信息与费用数据,按救助标准分5个政策期,统计描述不同政策期内救助患者数量及各项费用的时间和地区分布,采用卡方检验和秩和检验比较救助数量和费用指标在不同政策期、成都市三圈层及不同经济水平地区的分布差异。结果 2009年6月—2017年10月,共救助患者11432人次,年均标准化救助人次数平均增加48%,经济较发达地区救助数量增加明显;住院医疗费补偿总额、住院生活补助明显增加,环比增加速度达34.6%;医保分摊比例49%~69%,经济欠发达地区较高;住院生活补助在近成都市圈层、经济较发达地区较高。结论 成都市精神障碍救助负担逐年增加,救助费用投入存在地区差异,费用补偿重点向贫困地区倾斜,住院生活补助逐渐与当地经济水平相一致。后期可应用大数据技术建设患者信息管理与跨区域医疗服务电子化管理平台,以便基于客观数据适时循证决策。Objective To understand the spatial and temporal distribution of burden and expenses of patients with severe mental disorder(SMD)under Sunshine Assistance Policy in Chengdu,and provide evidences for improving policy effectiveness.Methods Data of hospitalization and expenses of patients were collected from 13 specific hospitals.The data was divided into 5 periods with different policy assistance plans,and descriptive analysis was used to show the distribution of patients'number and expenses during various periods and at different areas with various distances from the city center or with different economic levels in Chengdu.Chi-square test and Mann-Whitney U test were used to compare differences of above distributions.Results From June 2009 to October 2017,11 432 SMD cases were assisted and the average number of case increased by 48%per year,especially in more developed areas.The total hospitalization expense and inpatient subsistence allowance kept increasing obviously with ring ratio being as high as 34.6%;the proportion of medical insurance reimbursement varied from 49%to 69%,and was higher in less developed areas.The inpatient subsistence allowance showed higher in regions nearer to Chengdu center and/or with higher economic level.Conclusion The burden of SMD in Chengdu keep increasing and the expenses input show regional characteristics which pay more consideration to the poor regions and meanwhile keep consistent with the local economic level.In the future,patients'information management system and electronic platform for cross-regional medical services should be constructed by using big data techniques,so as to improve evidence-based decision based on timely data.

关 键 词：严重精神障碍 阳光救助 费用 地区分布 

分 类 号：R195[医药卫生—卫生统计学]