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Geriatric psychiatry development in health care settings in mainland China: Challenges and outlook
International Journal of Geriatric Psychiatry ( IF 4 ) Pub Date : 2020-05-20 , DOI: 10.1002/gps.5317
Jing Wang 1, 2 , Fei Sun 3 , Qi Qiu 1 , Qingwei Li 1, 4 , Qunying Zhang 5 , Haibo Yang 6 , Jiayuan Qiu 1 , Mo Zhu 1 , Xia Li 1, 7
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Dear Editor, China has the largest older population in the world. In 2019, those aged 65 accounted for 12.6% of its total population, and more than 50 million Chinese lived with different types of dementias or cognitive impairment. Chinese older adults also suffer from depression, anxiety, and other mental health disorders. All these call for growing geriatric psychiatry services in China. We collected data from directors of 21 geriatric psychiatry departments in China, and identified four management models: closed ward in regional psychiatric hospitals (n = 12) that treat chronic schizophrenia and late-stage dementias, closed ward in tertiary psychiatric hospitals (n = 5) that treat severe behavioral problems and depression, open ward in tertiary psychiatric hospitals (n = 3) and open ward in tertiary general hospital (n = 1) that treat mood disorders and common mental disorders. The average length of hospitalization ranges from 16 to 1056.6 days, the daily expenditures of unit bed ranged from $49.1 to $133.3, percentage of patients with medical insurance ranged from 82.7% to 96.1%, and percentage of new patients ranged from 5.9% to 75.0% (see Table 1). In China, regional psychiatric hospitals mainly provide services for people in designated residential districts. In order to relieve financial burden for geriatric psychiatric patients, the government reduces inpatient copay in regional hospitals, which are less than 10% of the total cost. Furthermore, China's long existed one-child family planning policy has led to a 4:2:1 family structure, which challenges adult children's capacity to take care of older parents with mental disorders. With low copay and heavy care burden, the families are likely to falsely believe regional psychiatric wards are the “cheapest nursing home,” as evidenced by the lengthy hospitalization days (ie, an average of 1056.64 days), few newly admitted patients (ie, 5.85%). Tertiary hospitals, on the provincial or national level, are subject to strict government regulations and evaluations. Tertiary hospitals need to measure up to the requirements of the governmental evaluation system that emphasizes on short turn over time, but also meet the patients' long-term care needs that they would not otherwise receive somewhere else. We identified three strategies used by geriatric departments in tertiary hospitals to solving the dilemma. One closed geriatric psychiatry department of a tertiary psychiatric hospital in this study achieved rapid turnover and shortened the average length of stay by increasing the proportion of out of pocket expenses. Its rate of government insured patients is 30%, which is far lower than that of 85% of the same type hospital (ie, Shanghai Mental Health Center). The second strategy used by one closed geriatric psychiatry department in a tertiary psychiatric hospital was to place young and older patients in the same ward. As young patients have shorter length of hospitalization, it contributes to an overall reduced length and meets the government evaluation standards. The third strategy used by three tertiary psychiatric hospitals adopted the management model of general hospitals and implemented open wards. The percentage of new patients in the open ward was significantly higher than that in the closed ward, and the cost per bed was significantly lower than that in the closed ward. The open ward mainly treats patients with depression and anxiety, requiring family caregivers to be with patients during the whole
更新日期:2020-05-20
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