ECONOMIC ASPECTS OF MENTAL HEALTH CARE

ECONOMICS AND SYSTEMS OF CARE IN PSYCHIATRY

S.S. Sharfstein

Sheppard Pratt Health System, Baltimore, MD, USA

As the science and art of psychiatric treatment have improved and more patients can benefit from psychiatric diagnosis and care, the demand for these valued services increases dramatically. The supply of qualified practitioners, how they are organized in systems of care, and the cost of treatment are strategic issues for policy makers in both the private and public sectors. Economics is the science and art of rationing and can have a profound impact on how we are able to meet human needs in the medical marketplace. This paper will examine the supply and demand characteristics of the psychiatric medical marketplace and focus on various strategies to promote access and contain costs. As psychiatric treatment has become more effective and individualized, the stigma associated with seeking such care has decreased, and the demand for care has increased dramatically. How we then organize the provision of such services becomes a matter of vital concern to clinicians, patients and their families, and government. Various efforts at social insurance must consider economics in order to understand the consequences of such financing for access to care, quality, and costs. How these issues are evolving in the United States, at national and local levels, will be the main focus of this paper.

MENTAL HEALTH POLICY AND ECONOMICS RESEARCH

M. Moscarelli

International Center of Mental Health Policy and Economics, Milan, Italy

Mental health policy and economics research is increasingly demonstrating its importance in providing decision-making with crucially needed information on a wide range of issues, including : a) socioeconomic burden of mental and addictive disorders, and the costs they impose on patients, family caregivers, workplace and society ; b) impact of clinical, social, and financial interventions on health, quality of life and economic well-being of the affected populations ; c) costs of alternative management systems for providing comprehensive clinical and social services, and the socio-economic impact of policies encouraging community-based care ; d) analysis of the cost/effectiveness of psychological or pharmacological interventions in speciality and general practice settings ; e) evaluation of the consequences of different financing and reimbursement methods on health care provision, efficiency, and health outcomes ; f) analysis of special and particularly vulnerable populations (i.e. severely disabling mental illnesses, co-morbidities of mental and addictive disorders) that need complex multilevel co-ordination of clinical, social and financial interventions. Systematic interdisciplinary collaboration among psychiatrists, health services researchers, health economists, and public health researchers is required for obtaining sound scientific information in this field. This integrated approach brings together the strengths of each discipline to provide the best possible information to support the complex policy decisions regarding the provision of effective interventions for prevention, care and rehabilitation, and their adequate proper financing,

CONTEMPORARY EFFECTS OF MANAGED CARE IN THE USA

D.B. Borenstein

Department of Psychiatry, University of California at Los Angeles, CA, USA

In the late 1980s, as health care costs in the United States rose beyond 11 percent of the gross domestic product, employers turned to managed care in an effort to diminish their expenses, Most employers decided that psychiatric illnesses and their treatments could not be evaluated and managed in same way as other medical illnesses. Managed behavioral health care came into existence to fill this need. At the time, there was inadequate research to document the accuracy of psychiatric diagnosis and the cost-effectiveness of psychiatric treatment. This presentation will provide highlights of recent research documenting the effects of behavioral managed care in the United States. It will focus on costs, quality of care and access to treatment for psychiatric illnesses.

UNDERSTANDING MENTAL HEALTH SERVICE COST DRIVERS : A NEW ZEALAND CASEMIX DEVELOPMENT STUDY

G.W. Mellsop

Auckland Clinical School, University of Auckland, New Zealand

« Casemix » methods of funding health services have been quite extensively developed in parts of the world, Attempts to developing mental health casemix systems have usually been greeted unenthusiastically, because so little variance in the costing could be attributed to diagnosis, and so much variance appeared to be solely dependant on the idiosyncrasies of the provider. A large research project was implemented in New Zealand to develop a pilot casemix classification which could be used for service management purposes, to infonn funding, to provide benchmarks and to model the routine use of outcome information. Three major data blocks were captured for the study. These were service financial information, service utilisation data, and consumer characteristics. These were entered into a regression analysis model to explain the cost drivers of « episodes of care ». An episode of care was arbitrarily defined as a 91-day period. 19,239 episodes of care were captured over a six-month study period. These were provided to a total of 12,576 individuals. A 42-class, pilot, classificatory system was developed. The branching tree from « all episodes » proceeded in this analysis 5 steps, which overall explained 78% of the variance. The first split was into inpatient or community. Within each of those, next split was adult versus child and youth. Thereafter the splitters included age, Health of the Nation Outcome Scales (HONOS) items, legal status, etnicity, and in a few cases, diagnoses.