ECONOMIC-REFORMS AND THE ACUTE INPATIENT CARE OF PATIENTS WITH SCHIZOPHRENIA - THE CHINESE EXPERIENCE

Objective: This study compared insured and uninsured schizophrenic inp atients in China and examined changes in the acute inpatient care of s chizophrenic patients during China's economic reform era. Method: Deta iled chart reviews of 50 randomly selected inpatients discharged from a hospital in central China each year from 1984 through 1993 identifie d 321 patients with schizophrenia. Demographic, insurance, treatment, al-id cost data of these patients were collected from the charts. Resu lts: With logistic regression models to control for confounding variab les, the analyses showed that the 129 insured patients were significan tly more likely than the 192 uninsured patients to be urban residents, to be older, to hare had 7 or move years of schooling, and to have ha d more psychiatric hospitalizations; moreover, their index admissions were longer and were more likely to include use of traditional Chinese medications. The estimated 19% of schizophrenic individuals in the co mmunity with health insurance receive inpatient treatment 2.8 times mo re frequently than the 81% without insurance. Compared to admissions i n 1984-1988, admissions in 1983-1993 were significantly shorter and in volved longer periods of polypharmacy with multiple antipsychotic medi cations brit included lower mean chlorpromazine-equivalent doses of me dication. The relative cost of inpatient care for an acute episode of schizophrenic increased 3.5-fold over the 10-year period, from 11% of mean annual household income in 1984 to 37% in 1993. Conclusions: Chan ges in the incentive system for care providers and rapid increases in the cost of care during the economic reform era have resulted in incre asingly restricted availability of services for the many schizophrenic patients without health insurance.