Influence of Policy Factors on Healthcare-seeking Behaviors in Patients with Schizophrenia
Background In China, schizophrenia patients have a high demand for basic medical care, but irrational healthcare-seeking behaviors among them may cause a waste of health resources. So relevant policies have been promulgated to improve the ensuring of healthcare and reasonably guide schizophrenia patients to seek medical care. The current research on policy factors and healthcare-seeking behaviors has rarely addressed the association between mental health policies and healthcare-seeking behaviors of patients with schizophrenia. Objective To analyze the influence of policy factors on healthcare-seeking behaviors in schizophrenia patients, to understand the status and outcome of health service utilization in this group under the guidance of basic medical insurance policies and mental health policies, providing empirical evidence for policy improvement. Methods In November 2019, we obtained a sample of 2 314 schizophrenic individuals with valid key data by matching the personal data in the three-level psychiatric prevention and treatment network system in a district of Chongqing in 2018, with information related to personal health service utilization in the district obtained from the medical insurance information platform of Chongqing Human Resources and Social Security Bureau. Multivariate Logistic regression analysis was conducted with healthcare-seeking behaviors and the medical institution chosen for treatment as explained variables, participation in basic medical insurance (including basic medical insurance for rural and urban non-working residents or basic medical insurance for urban employees, and reimbursement for medical cost due to special outpatient diseases) and mental health policy coverage (involving community rehabilitation services, guardianship subsidy, subsidy from the local disability federation, subsidy from the 686 program, and free second-generation antipsychotics, and the mental disability certificate) as key explanatory variables, and patients' demographic characteristics as control variables. Results Of the participants, 1 915 (82.76%) had medical visits, including 1 482 seeking outpatient treatment, and 795 seeking inpatient treatment. Among those seeking outpatient treatment, the prevalence of choosing primary, secondary and tertiary care institutions was 17.01% (252/1 482), 72.87% (1 080/1 482), and 10.12% (150/1 482), respectively. And the prevalence of choosing primary, secondary and tertiary care institutions for inpatient treatment was 4.78% (38/795), 65.16% (518/795), and 30.06% (239/795), respectively. Logistic regression analysis showed that the type of basic medical insurance, reimbursement for medical cost due to special outpatient diseases, receiving community rehabilitation services, enrolment in the 686 program and involvement in the free second-generation antipsychotics program were factors associated with healthcare-seeking behaviors (P<0.05). The type of basic medical insurance, reimbursement for medical cost due to special outpatient diseases, receiving community rehabilitation services, enrolment in the free second-generation antipsychotics program, and the level of mental disability were factors associated with choosing outpatient settings for treatment (P<0.05). The type of basic medical insurance and the level of mental disability were associated with choosing inpatient settings for treatment (P<0.05) . Conclusion Policy factors played a positive role in guiding schizophrenia patients to seek medical treatment, but some problems were also revealed, such as low patient participation and insufficient coverage pathways. In view of this, efforts should be made as soon as possible to optimize mental health policies and the social support and assistance system, increase patient participation of relevant programs via strengthening the publicity of relevant policies, actively guide home-based rehabilitation activities, further promote community-based delivery of mental health services, and continuously improve the mental health security system..
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
Zhongguo quanke yixue - 26(2023), 19, Seite 2385-2394 |
| Sprache: |
Chinesisch |
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| Beteiligte Personen: |
LIU Rui, DENG Jing, CHEN Ailing, CHENG Peihua, LUO Xingneng, HU Yongjiao, ZHANG Munan [VerfasserIn] |
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| Links: |
doi.org [kostenfrei] |
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| Themen: |
Medicine |
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| doi: |
10.12114/j.issn.1007-9572.2022.0680 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
DOAJ091491002 |
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| 520 | |a Background In China, schizophrenia patients have a high demand for basic medical care, but irrational healthcare-seeking behaviors among them may cause a waste of health resources. So relevant policies have been promulgated to improve the ensuring of healthcare and reasonably guide schizophrenia patients to seek medical care. The current research on policy factors and healthcare-seeking behaviors has rarely addressed the association between mental health policies and healthcare-seeking behaviors of patients with schizophrenia. Objective To analyze the influence of policy factors on healthcare-seeking behaviors in schizophrenia patients, to understand the status and outcome of health service utilization in this group under the guidance of basic medical insurance policies and mental health policies, providing empirical evidence for policy improvement. Methods In November 2019, we obtained a sample of 2 314 schizophrenic individuals with valid key data by matching the personal data in the three-level psychiatric prevention and treatment network system in a district of Chongqing in 2018, with information related to personal health service utilization in the district obtained from the medical insurance information platform of Chongqing Human Resources and Social Security Bureau. Multivariate Logistic regression analysis was conducted with healthcare-seeking behaviors and the medical institution chosen for treatment as explained variables, participation in basic medical insurance (including basic medical insurance for rural and urban non-working residents or basic medical insurance for urban employees, and reimbursement for medical cost due to special outpatient diseases) and mental health policy coverage (involving community rehabilitation services, guardianship subsidy, subsidy from the local disability federation, subsidy from the 686 program, and free second-generation antipsychotics, and the mental disability certificate) as key explanatory variables, and patients' demographic characteristics as control variables. Results Of the participants, 1 915 (82.76%) had medical visits, including 1 482 seeking outpatient treatment, and 795 seeking inpatient treatment. Among those seeking outpatient treatment, the prevalence of choosing primary, secondary and tertiary care institutions was 17.01% (252/1 482), 72.87% (1 080/1 482), and 10.12% (150/1 482), respectively. And the prevalence of choosing primary, secondary and tertiary care institutions for inpatient treatment was 4.78% (38/795), 65.16% (518/795), and 30.06% (239/795), respectively. Logistic regression analysis showed that the type of basic medical insurance, reimbursement for medical cost due to special outpatient diseases, receiving community rehabilitation services, enrolment in the 686 program and involvement in the free second-generation antipsychotics program were factors associated with healthcare-seeking behaviors (P<0.05). The type of basic medical insurance, reimbursement for medical cost due to special outpatient diseases, receiving community rehabilitation services, enrolment in the free second-generation antipsychotics program, and the level of mental disability were factors associated with choosing outpatient settings for treatment (P<0.05). The type of basic medical insurance and the level of mental disability were associated with choosing inpatient settings for treatment (P<0.05) . Conclusion Policy factors played a positive role in guiding schizophrenia patients to seek medical treatment, but some problems were also revealed, such as low patient participation and insufficient coverage pathways. In view of this, efforts should be made as soon as possible to optimize mental health policies and the social support and assistance system, increase patient participation of relevant programs via strengthening the publicity of relevant policies, actively guide home-based rehabilitation activities, further promote community-based delivery of mental health services, and continuously improve the mental health security system. | ||
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