title: Mental health inpatient treatment expenditure trends in China, 2005-2012: evidence from Shandong.
abstract: BACKGROUND
  Mental health is increasingly becoming a huge public health issue in China. Yet for various cultural, healthcare system, and social economic reasons, people with mental health need have long been under-served in China. In order to inform the current on-going health care reform, empirical evidences on the economic burden of mental illnesses in China are urgently needed to contribute to health policy makers' understanding of the potential benefits to society from allocating more resources to preventing and treating mental illness. However, the cost of mental illnesses and particularly its trend in China remains largely unknown.
  
  
  OBJECTIVE
  To investigate the trend of health care resource utilization among inpatients with mental illnesses in China, and to analyze what are the factors influencing the inpatient costs.
  
  
  METHODS
  Our study sample included 15,721 patients, both adults and children, who were hospitalized over an eight-year period (2005-2012) in Shandong Center for Mental Health (SCMH), the only provincial psychiatric hospital in Shandong province, China. Data were extracted from the Health Information System (HIS) at SCMH, with detailed and itemized cost data on all inpatient expenses incurred during hospitalization. The identification of the patients was based on the ICD-10 diagnoses recorded in the HIS. Descriptive analysis was done to analyze the trend of hospitalization cost and length of stay during the study period. Multivariate stepwise regression analysis was conducted to assess the factors that influence hospitalization cost.
  
  
  RESULTS
  Among the inpatients in our sample, the most common mental disorders were schizophrenia, schizotypal and delusional disorders. The disease which had the highest per capita hospital expense was behavioral and emotional disorders with onset usually occurring in childhood and adolescence (RMB 8,828.4; US$ 1,419.4, as compared to the average reported household annual income of US$ 2,095.3 in China). The average annual growth rate of per capita hospitalization cost was 23.6%, with the inpatient cost reaching RMB 11,949 (US$ 1921.1) in 2012. The hospitalization cost was found to be strongly associated with hospital length of stay, level of care, age, employment status, admission diagnoses, and frequency of hospitalization.
  
  
  CONCLUSIONS
  Our study found that mental health inpatient resources use, particularly hospitalization cost, has been growing at an increasing rate. In our sample, hospitalization cost nearly tripled from 2005 to 2012. Mental illnesses and the related economic burden on the population will continue to grow, making mental health a major public health issue in China. Hospital length of stay was found to be increasing in our sample, and positively correlated with hospitalization cost. Childhood and adolescence behavioral and emotional disorders were found to be significantly associated with higher inpatient cost.
  The policy implications generated from the results of this study are two-fold: first of all, in order to meet the growing need of mental health care in China, the government needs to significantly increase its spending in preventing and treating mental illnesses. Second, cost containment in inpatient care would become a major challenge for mental health policy makers in China. Government support, clinical practices and guideline development, as well as research are urgently needed to promote mental health prevention and improve the efficiency of mental health system in China. The current mental health system, like the overall healthcare system in China, relies heavily on hospital inpatient care. In order to build a sustainable mental health care system to meet increasing population need in China, it is crucial to integrate mental health care reform with the ongoing primary health care reform. Future mental health policy reform and research in China should put more focus on how to strengthen primary care system as well as community support, establish effective two-tier referring mechanism between hospital and primary care system, and to ensure continuity of care.
authors.forename: Junfang
authors.initials: J
authors.lastname: Xu
authors.affiliation: Center for Health Economic Experiments and Public Policy, School of Public Health, Shandong University, China, wangjiannan@sdu.edu.cn.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.forename: Ruiyun
authors.initials: R
authors.lastname: Liu
authors.forename: Jinshui
authors.initials: J
authors.lastname: Xing
authors.forename: Lei
authors.initials: L
authors.lastname: Su
authors.forename: Fenghua
authors.initials: F
authors.lastname: Yu
authors.forename: Mingshan
authors.initials: M
authors.lastname: Lu
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D005260:Female; D017722:Hospital Charges / Q000639:trends*; D006760:Hospitalization / Q000191:economics* / Q000639:trends; D006778:Hospitals, Psychiatric / Q000191:economics* / Q000639:trends; D006801:Humans; D007297:Inpatients; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy*; D008875:Middle Aged; D012959:Socioeconomic Factors