Mental health system costs, resources and constraints in South Africa: a national survey
Mental health system costs, resources and constraints in South Africa: a national survey
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DOI：
10.1093/heapol/czz085
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发表时间：
2019-11-01
影响因子：
3.2
通讯作者：
Lund, Crick
中科院分区：
文献类型：
--
作者：
Docrat, Sumaiyah;Besada, Donela;Lund, Crick
将心理健康纳入可持续发展目标代表着将心理健康列为最高的健康和发展投资优先事项的全球承诺。低收入和中等收入国家，如南非，考虑将扩大精神卫生系统纳入更广泛的全民健康覆盖相关卫生系统改革，需要对现有精神卫生系统资源和制约因素进行详细的和当地派生的估计。缺乏这些数据限制了在大多数LMIC中解决精神障碍负担的扩大努力。我们进行了一项全国调查，以量化公共精神卫生支出，并评估南非精神卫生系统的制约因素。研究发现，2016/17财政年度南非公共精神卫生支出为6.153亿美元，占公共卫生预算总额的5.0%(省级范围：省级卫生预算的2.1-7.7%)，人均未参保13.3美元。住院护理占精神卫生保健支出的86%，其中近一半的精神卫生总支出发生在精神病院一级。近四分之一的精神疾病住院患者在上次出院后3个月内再次入院，这给公共卫生系统造成的损失估计为1.12亿美元。粗略估计表明，在研究期间，需要护理的未参保人口中只有0.89%和7.35%接受了某种形式的公共住院和门诊精神保健。此外，精神卫生人力资源的可获得性、基础设施和药物供应是该国逐步实施精神卫生立法的重大制约因素。这项研究首次提供了具有全国代表性的精神卫生支出状况的反映，并阐明了南非现有精神卫生投资的低效和制约因素。有了这些信息，政府现在有了一个基线，可以启动一个合理的程序来规划体制改革。
The inclusion of mental health in the Sustainable Development Goals represents a global commitment to include mental health among the highest health and development priorities for investment. Low- and middle-income countries (LMICs), such as South Africa, contemplating mental health system scale-up embedded into wider universal health coverage-related health system transformations, require detailed and locally derived estimates on existing mental health system resources and constraints. The absence of these data has limited scale-up efforts to address the burden of mental disorders in most LMICs. We conducted a national survey to quantify public expenditure on mental health and evaluate the constraints of the South African mental health system. The study found that South Africa's public mental health expenditure in the 2016/17 financial year was USD615.3 million, representing 5.0% of the total public health budget (provincial range: 2.1-7.7% of provincial health budgets) and USD13.3 per capita uninsured. Inpatient care represented 86% of mental healthcare expenditure, with nearly half of total mental health spending occurring at the psychiatric hospital-level. Almost one-quarter of mental health inpatients are readmitted to hospital within 3 months of a previous discharge, costing the public health system an estimated USD112 million. Crude estimates indicate that only 0.89% and 7.35% of the uninsured population requiring care received some form of public inpatient and outpatient mental healthcare, during the study period. Further, mental health human resource availability, infrastructure and medication supply are significant constraints to the realization of the country's progressive mental health legislation. For the first time, this study offers a nationally representative reflection of the state of mental health spending and elucidates inefficiencies and constraints emanating from existing mental health investments in South Africa. With this information at hand, the government now has a baseline for which a rational process to planning for system reforms can be initiated.