Cost of Treating Medical Conditions in Psychiatric Inpatients in Zhejiang, China

Background: Few studies in China assess the relative costs of treating psychiatric and non-psychiatric medical conditions among psychiatric patients. This information is important for the planning of mental health services and of health insurance packages.Objective: Assess the breakdown of the 2010 costs of psychiatric inpatient care in a representative sample of psychiatric hospitals in Zhejiang Province, China.Methods: A two-stage stratified sampling method was used to select 14 of the 42 psychiatric hospitals in Zhejiang and then discharges for three randomly selected months (March, July and November) in 2010 at these hospitals were selected for assessment. A standardized form was used to collect information about the demographic and clinical characteristics of the patients and about the various components of the costs of inpatient care.Results: 7,684 inpatient admissions were included. The median (interquartile range) length of stay was 30 (20-52) days and the median total cost of admission was 10,005 (6,419-14,728) Chinese Yuan (1,539 $US). The median cost of medication was 2,512 (1,161-4,182) Yuan, 65% of which was for non-psychiatric medications. 1,798 (24.3%) of the admissions had one or more co-morbid medical condition that required treatment, including hypertension, leucopenia, diabetes and different types of infections. The prevalence and type of medical condition varied significantly for patients with different classes of psychiatric diagnoses. After adjustment for other factors the presence of a co-morbid medical condition significantly increased the cost of hospitalization but not the duration of hospitalization. For inpatients with schizophrenia the cost of their psychiatric medications was significantly higher than the cost of their non-psychiatric medications but the opposite was true for patients with other diagnoses.Conclusion: Treatment of somatic conditions account for a high proportion of the cost of inpatient treatment in psychiatric hospitals. Plans to revise the reimbursement mechanisms for mental disorders, to develop diagnostic-related group payment schemes, and to establish diagnostic-specific treatment guidelines need to take into consideration the high prevalence and associated costs of treating somatic conditions that frequently accompany psychiatric illnesses. And the in-service training of psychiatrists needs to ensure that they are up-to-date on recent advances in the diagnosis and treatment of common physical disorders.