| Background:Mental disorder has already threatened the health of Chinese citizens. Currently around China, there are about 16 million patients who suffer from mental disease. Nerve and mental disease ranks first (20%) of the burden of disease in China. The special mental health institution, as an important part of mental health service system, is the service principal of mental health prevention and control.Objective:By investigating the special mental health institutions of various province-level, city-level and county-level in China, this paper analyzes the factors that influence economic operations of mental health institutions, and comes up with some suggestions, which may help motivate the development of these institutions and offer some references for new regulations.Methods:By making use of methods including literature review, personal interview and observation, this paper categorized and organized the collected documents and research reports. We also made a systematic summary of current operations of Chinese special mental health institutions and related policies, and carried out thorough interviews with staffs who worked in 14 institutions within five provinces in my research. In the quantitative research, we analyzed statistics data of financing and economic operations, charging of diagnosis and treatment, reimbursement of medical insurance, use of medicines, conditions of beds and human resources in these institutions. In addition, questionnaires were done among patients and their companions in hospitals. We used the cost accounting method to calculate the cost of psychiatric nursing services and psychological counseling/treatment item based on human consumption and time-consuming. Results:1. From 2006 to 2010, in mental hospitals the financial aid amounts to 23%-27% in the whole gross incomes, and the proportion of personnel expenses in gross incomes gradually drops year by year. In general, the financial input in these institutions is insufficient, and it varies in different levels and regions. In the institutions of provincial levels of the eastern provinces, the rate of financial input is much higher. In 2010, the financial input of Al and B1 hospital amounts to 51.27% and 51.26%. On the city-level, the financial input in middle and western province is only 23.60% and 9.14%. The financial input in institutions of county level is much lower than those of provincial level. In 2010, E2 has the lowest rate (2.42%), and B2 has the highest rate (23.68%). The financial input in institutions of country level stays at a rather low level (1.49%-36.31%).2. Due to the limit of sites, equipments, staffs and reimbursement of health insurance, in mental health institutions various treatments cannot be carried out, though they are supposed to be launched. The charge of diagnosis and treatment items is quite low. The daily fee of beds in these institutions is only 1/5 of that in a general hospital. After the cost accounting, we found that the charges of nursing care services and psychological consultation/treatment were much lower than costs. Here we list the cost accounting result of nursing care services in Al of Liaoning province as an example:the intensive nursing care is 12.1 yuan/hour, the total costs of first-grade and second-grade nursing care service is 205.5yuan/day and 116.5yuan/day respectively, and the cost of psychological consultation/ treatment services is 86.01yuan each time. However, currently the charges of these are lOyuan/day and 30yuan each time.3. The questionnaires done among 1537 patients who are in hospitals showed that these patients usually had quite low household incomes. Patients who come from rural areas and have less than 10000RMB annual household incomes amount to 74.42%. About one-third of the patients had to bear the cost of treatment at their own expense. In 2010, the average hospitalization fees in eastern, middle and western institutions are 10653.42,4824.33 and 4902.33yuan. For city workers, the rate of hospitalization reimbursement in health insurance is above 85%. Comparatively the New Cooperative Medical Scheme provides patients with a much lower rate of hospitalization reimbursement, and the actual rate is about 45%-60%. What's more, the proportion of reimbursement in outpatient service is extremely low, and in some provinces and cities, patients must pay by themselves.4. An statistic analysis on the use of medicines in three provincial mental hospitals showed that in A1 B1,C1, the anti-mental diseases medicines that most frequently used are chlorpromazine, risperidone and clozapine. The anti-anxiety medicines most frequently used are alprazolam, nitrazepam and Lorazepam. The most frequently used anti-mania medicine is lithium carbonate and the anti-depression medicine is citalopram, mirtazapine and sertraline.5. The research shows that in 2010, the density of beds in mental hospitals of five provinces and cities is 2.89,1.34,0.76,5.55, and 0.92 bed/10000 people. The average around China is 1.58 bed/10000 people. On the average, only 1.53 psychiatry doctors are available for 100000 people. These are below the international level. The rate of bed occupation in provincial and city institutions exceeds 95%(except A1), and in institutions of county level, the rate is low (lower than 85%). The health technical personnel were met the basic configuration requirements but in seven institutions the number of staffs is below the standard.Conclusion:The economic operation of mental health institutions deserves our concern. The insufficient financial input, bad technologies and equipments, shortage of staffs and unfriendly policy and regulation protections, etc, lead to the difficulty in mental health institutions. Governments at all levels should bring the mental health problem into the integrated plan of social development, enlarge the financial inputs, and ensure that the unprivileged people can have basic mental health service. Appropriate medical pricing system is indispensable, and this can help reveal values of medical personnel's work. Governments also should improve the mental health financing and payment system, expand health insurance drug list and enlarge the rate of reimbursement of the new rural cooperative medical scheme. Moreover, the development of medical talents group also attracts great concern.Innovation points:In this study, we analyzed the economic operation of the special institutions from five aspects, including the financial input, charge of diagnosis and treatment items, drug use and allocation of resources to conduct a comprehensive analysis, preliminary revealed the problems in the process of economic operation of the special mental health institutions. Besides, we analyzed the influencing factors and provided applicable recommendations. We used the cost accounting methods to calculate the cost of psychiatric nursing services and psychological counseling/treatment items based on human consumption and time-consuming firstly. Preliminary explored a new method of medical services costing, and provided a reference for the formulation of the price of medical services.
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