Geographical Variation in Psychiatric Admissions Among Recipients of Public Assistance

Abstract

Background Understanding the area-specific resource use of inpatient psychiatric care is essential for the efficient use of the public assistance system. This study aimed to assess the geographical variation in psychiatric admissions and to identify the prefecture-level determinants of psychiatric admissions among recipients of public assistance in Japan. Methods We identified all recipients of public assistance who were hospitalized in a psychiatric ward in May 2014, 2015, or 2016 using the Fact-finding Survey on Medical Assistance. The age- and sex-standardized number of psychiatric admissions was calculated for each of the 47 prefectures, using direct and indirect standardization methods. Results A total of 46,559 psychiatric inpatients were identified in May 2016. The number of psychiatric admissions per 100,000 population was 36.6. We found a 7.1-fold difference between the prefectures with the highest (Nagasaki) and lowest (Nagano) numbers of admissions. The method of decomposing explained variance in the multiple regression model showed that the number of psychiatric beds per 100,000 population and the number of recipients of public assistance per 1,000 population were the most important determinants of the number of psychiatric admissions ( R 2 = 28% and R 2 = 23%, respectively). The sensitivity analyses, using medical cost as the outcome and data from different survey years and subgroups, showed similar findings. Conclusions We identified a large geographical variation in the number and total medical cost of psychiatric admissions among recipients of public assistance. Our findings should encourage policy makers to assess the rationale for this variation and consider strategies for reducing it.

The Basic Act for Suicide Prevention: Effects on Longitudinal Trend in Deliberate Self-Harm with Reference to National Suicide Data for 1996–2014

“…The rate of receipt of public assistance was particularly high in drug poisoning cases. In addition, some recipients of public assistance tend to abuse psychotropic medication [ 21 ]. Furthermore, most drug poisoning cases in Japan involved current or previous exposure to psychotropic medication [ 22 ].…”

Prevalence of type 2 diabetes by age, sex and geographical area among two million public assistance recipients in Japan: a cross-sectional study using a nationally representative claims database

“…The Fact-finding Survey on Medical Assistance (FSMA) data were used to obtain the number of patients 12,13 . The National Survey on Public Assistance Recipients (NAPSR) data were used to obtain the number of PAR.…”

Mental health service areas in Switzerland

“…Comparisons of small areas have repeatedly demonstrated wide variations in health care expenditures and utilization rates—both in medical and surgical (Ashton et al., 1999; Birkmeyer et al., 1998; Chassin et al., 1986; Coyte et al., 1996; Gittelsohn & Powe, 1995; Keller et al., 1990; Knickman & Foltz, 1984; Lewis, 1969; McPherson et al., 1982; Wennberg & Gittelsohn, 1973) as well as in psychiatric services (Almog et al., 2004; Ashton et al., 1999; Curtis et al., 2009; Gottlieb et al., 2021; Hendryx & Rohland, 1994; Hendryx et al., 1995; Okumura et al., 2019; Watts et al., 2011). Such‐wide variations cannot be fully explained by underlying differences in the prevalence or incidence of conditions.…”