Patterns of mental health service utilization in a general hospital and outpatient mental health facilities |
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Authors: | Enrique Baca-Garcia Maria M. Perez-Rodriguez Ignacio Basurte-Villamor F. Javier Quintero-Gutierrez Juncal Sevilla-Vicente Maria Martinez-Vigo Antonio Artes-Rodriguez Antonio L. Fernandez del Moral Miguel A. Jimenez-Arriero Jose L. Gonzalez de Rivera |
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Affiliation: | (1) Department of Neurosciences, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, Suite 2917/Unit 42, New York, NY 10032, USA;(2) Department of Psychiatry, Fundacion Jimenez Diaz Hospital, Avda. Reyes Católicos, 2, Madrid, 28040, Spain;(3) Department of Psychiatry, Faculty of Medicine, Autonoma University of Madrid, Calle Arzobispo Morcillo 2, Madrid, 28029, Spain;(4) Department of Psychiatry, Ramon y Cajal Hospital, Carretera de Colmenar Viejo Km 9,100, 28034 Madrid, Spain;(5) Department of Signalling Theory, Telecommunication Engineering Faculty, Carlos III University, Edif. Torres Quevedo, Avda. Universidad 30, 28911 Leganes, Madrid, Spain;(6) Mental Health Center of Centro District, C/Cabeza, 4. 1a planta, Madrid, 28012, Spain;(7) Mental Health Center of Arganzuela District, Complutense University of Madrid, Madrid, Spain;(8) Servicio de Psiquiatria (Edif. Medicina Comunitaria), University Hospital 12 de Octubre, Avenida de Córdoba s/n, Madrid, 28041, Spain |
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Abstract: | Purpose Mental health is one of the priorities of the European Commission. Studies of the use and cost of mental health facilities are needed in order to improve the planning and efficiey of mental health resources. We analyze the patterns of mental health service use in multiple clinical settings to identify factors associated with high cost. Subjects and methods 22,859 patients received psychiatric care in the catchment area of a Spanish hospital (2000–2004). They had 365,262 psychiatric consultations in multiple settings. Two groups were selected that generated 80% of total costs: the medium cost group (N = 4,212; 50% of costs), and the high cost group (N = 236; 30% of costs). Statistical analyses were performed using univariate and multivariate techniques. Significant variables in univariate analyses were introduced as independent variables in a logistic regression analysis using “high cost” (>7,263$) as dependent variable. Results Costs were not evenly distributed throughout the sample. 19.4% of patients generated 80% of costs. The variables associated with high cost were: age group 1 (0–14 years) at the first evaluation, permanent disability, and ICD-10 diagnoses: Organic, including symptomatic, mental disorders; Mental and behavioural disorders due to psychoactive substance use; Schizophrenia, schizotypal and delusional disorders; Behavioural syndromes associated with physiological disturbances and physical factors; External causes of morbidity and mortality; and Factors influencing health status and contact with health services. Discussion Mental healthcare costs were not evenly distributed throughout the patient population. The highest costs are associated with early onset of the mental disorder, permanent disability, organic mental disorders, substance-related disorders, psychotic disorders, and external factors that influence the health status and contact with health services or cause morbidity and mortality. Conclusion Variables related to psychiatric diagnoses and sociodemographic factors have influence on the cost of mental healthcare. |
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Keywords: | health care costs health services research mental health services logistic models |
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