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[A study of where mentally disordered people receive medical care in Fukuoka Prefecture].

OBJECTIVE
To investigate the "secondary medical regions" where mentally disordered people receive out-patient and in-patient medical care in Fukuoka prefecture, and examine factors related receiving care in medical facilities outside of their secondary medical region of residence.


METHODS
16,129 out-patients on June 30, 2001 using "the public assistance system of outpatients' medical expenses" in line with the Law on Mental Health and Welfare for People with Mental Disorders were analyzed. 7513 in-patients with mental disorders in hospitals were also analyzed utilizing data from the "Patient Survey" by the Ministry of Health and Welfare in 1999. Whether they received out-patient care and in-patient medical care in their own region of residence or not was clarified for all of 13 secondary medical regions. Univariate and multivariate analyses with the multiple logistic regression model were employed to evaluate the relationship between the medical care outside their residential region and characteristics, such as the secondary medical region, gender, age, diagnosis, medical care insurance and so on.


RESULTS
With out-patient care, patients in secondary medical regions with a small population size tended to receive care outside of their residential region. Other characteristics associated with a significantly an increased proportion receiving care outside of their region included; young age, receiving care in clinics, and medical care insurance as "public corporation staff mutual aid association" and "employees' insurance or government's managed health insurance". For in-patients care, patients in secondary medical regions with a small number of psychiatric beds per population showed a marked tendency to receive care outside of their residential region. A slight correlation was observed between population ant the proportion receiving care outside of their region. Young and diagnoses such as of "mental and behavioural disorders due to use of alcohol," "other mental or behavioural disorders" "neurotic, stress-related and somatoform disorders" or "mood [affective] disorders", were other characteristics associated with an increased proportion receiving care outside of their region.


CONCLUSIONS
With the societal prejudice against mental disorders and regional differences in psychiatric medical facilities, it is of interest that this study indicated that mental disordered people receive medical care in a wide and relatively close area beyond their secondary medical region of residence.