Journal of Mental Health Policy and Economics最新文献

{"title":"Issues in the design of studies for the economic evaluation of new atypical antipsychotics: the ESTO study","authors":"M.F. Drummond,&nbsp;M.R.J. Knapp,&nbsp;T.P. Burns,&nbsp;K.D. Miller,&nbsp;P. Shadwell","doi":"10.1002/(SICI)1099-176X(199803)1:1<15::AID-MHP2>3.0.CO;2-O","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199803)1:1<15::AID-MHP2>3.0.CO;2-O","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: Increasing attention is being focused on the costs of healthcare and the need for cost-effective treatments. Drugs for schizophrenia have not escaped this scrutiny, especially now that several new agents are available, with acquisition costs substantially higher than for established therapies. However, most of the existing evaluations of new drugs for schizophrenia have weak designs, either comparing health care costs before and after introduction of the new drug, or being based on modelling approaches incorporating numerous assumptions.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Aim of the Study&lt;/b&gt;: The aim of the study was to discuss and resolve the key design issues in the planning of a prospective randomized trial to assess the socio-economic impact of a new atypical antipsychotic (quetiapine).&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods&lt;/b&gt;: Key methodological issues were identified and discussed in the context of the economic evaluation being planned. These were patient recruitment and entry criteria, selection of comparator drug, blinding of doctor and patient, range of socio-economic outcomes, length of follow-up and sample size.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results&lt;/b&gt;: The resulting economic evaluation, the ESTO study, was an international multi-centre randomized controlled trial, with concurrent data collection for a wide range of clinical, economic and quality of life outcomes. The trial had a pragmatic design, enrolling patients experiencing an acute exacerbation on existing therapy. In addition to the presenting exacerbation, patients must have had at least one hospitalization or documented evidence of exacerbation within the previous three years. On admission to the study, existing psychotic medication was withdrawn prior to randomization to quetiapine or haloperidol. Doses of both drugs were titrated up to an optional dose, with flexibility for additional increases if required.&lt;/p&gt;&lt;p&gt;Both patients and doctors were blinded to treatment allocations, on the grounds that, since quetiapine was still in development, unblinded assessments of efficacy would not be credible. Patients were followed for 1 year, irrespective of whether they withdrew from study medication.&lt;/p&gt;&lt;p&gt;A wide range of socio-economic outcomes was assessed, including costs falling on the healthcare sector, other agencies and the family. In addition data were collected on patients’ earnings and quality of life, measured by the Short-Form 36 health profile. Data were also collected on a range of clinical measures, such as the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI), the AIMS neurological rating scale and the neurological rating scale of Simpson and Angus. This was to assess whether changes in socio-economic end points were indeed matched by changes in the patient’s clinical condition.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusions&lt;/b&gt;: The design of studies such as ESTO is inevitably a compromise between control and pragmatism. For example, whilst blinding of doctor and patient may reduce potential bias, this ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 1","pages":"15-22"},"PeriodicalIF":1.6,"publicationDate":"1998-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199803)1:1<15::AID-MHP2>3.0.CO;2-O","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72137661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician knowledge, financial incentives and treatment decisions for depression","authors":"Roland Sturm,&nbsp;Kenneth B. Wells","doi":"10.1002/(SICI)1099-176X(199807)1:2<89::AID-MHP12>3.0.CO;2-V","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199807)1:2<89::AID-MHP12>3.0.CO;2-V","url":null,"abstract":"<p><b>Background</b>: Two important policy levers to affect health care delivery are financing and informational interventions. Unfortunately, these two approaches have not been considered simultaneously and little is known about how their effects compare.</p><p><b>Aims of the Study</b>: This paper estimates the relative role of financial incentives (prepaid versus fee for service) and provider information (perceived knowledge of antidepressant medications and skill in counseling for depression) on quality of care for less and more severely depressed patients and their health and cost outcomes.</p><p><b>Methods</b>: We develop a theoretical model of provider behavior and estimate a reduced form using a multinomial probit model with heteroskedastic covariances. The likely effects of changing provider knowledge about depression treatment in primary care are then simulated and contrasted with the effects of a shift toward prepaid managed care as opposed to fee-for-service care. The empirical model is estimated using data from the Medical Outcomes Study.</p><p><b>Results</b>: We conclude that financing and information have different effects and that their combination can achieve the conflicting goals of improved health outcomes and reduced direct treatment goals. Moreover, including family income as one important dimension of social cost suggests that the combination of informational interventions and a shift to prepaid care may dominate either one intervention in isolation from a social cost perspective. Specifically regarding information, we found that increasing provider knowledge could have the highly desirable effect of greater targeting of treatments to sicker patients while not raising overall treatment rates much—a treatment pattern that many hoped managed care could achieve, but for which there has been little evidence.</p><p>Conclusions: Our analysis illustrates the value of considering these widely different policy goals simultaneously. We learned that variation in physician knowledge generally had stronger associations with clinically relevant practice patterns for depression than did a complete change in financing strategy. The moderate change in perceived knowledge we simulated (not near the extremes of observed values of perceived knowledge) was associated with enough improvement in appropriateness of care to more than offset the reduction in appropriateness with a complete shift from fee-for-service to prepaid managed care.</p><p><b>Implications for Health Policy</b>: The paper demonstrates the importance of considering different interventions simultaneously. Combining informational and financial interventions simultaneously can achieve better quality of care and reduce health care costs, something neither intervention can in isolation. © 1998 John Wiley &amp; Sons, Ltd.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 2","pages":"89-100"},"PeriodicalIF":1.6,"publicationDate":"1998-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199807)1:2<89::AID-MHP12>3.0.CO;2-V","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72137435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing informal care-giving","authors":"Ann M. Holmes,&nbsp;Partha Deb","doi":"10.1002/(SICI)1099-176X(199807)1:2<77::AID-MHP10>3.0.CO;2-5","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199807)1:2<77::AID-MHP10>3.0.CO;2-5","url":null,"abstract":"BACKGROUND: As downsizing of institutional care continues, patients discharged are likely to have more severe mental illnesses, and to have experienced longer tenures within institutions than patients who have been discharged in the past. As greater numbers of patients are removed from mental hospitals, the objective burden experienced by informal care-givers may increase, particularly if formal care levels are inadequate. AIMS OF THE STUDY: This paper documents who assumes informal care-giver roles, and the form such care-giving takes for patients discharged from a state hospital. Specifically, this paper identifies (i) what factors affect a person's decision to assume a care-giver role, including the participation of other network members in care-giving, (ii) what factors influence whether care-giving is provided in time or in direct purchase of care and (iii) how the patient's treatment location affects the decision of the network member to assume any care-giving role. DATA AND ANALYTICAL METHODS: Data for this paper are taken from a longitudinal study of the closure of a state mental hospital in central Indiana. Seventy-seven patients were asked to identify their community networks. Ninety-eight network members were surveyed about the informal care, both in time or through direct expenditures, they provided to these patients one year after discharge. Care-giving relationships were estimated using a multivariate probit model. Such a model estimates the extent to which the decision to provide care in either form depends on the care-giving activities assumed by other network members associated with a given patient, as well as the characteristics of individual patients and network members. RESULTS: Forty-one per cent of network members provided some level of informal care, with 13.3% providing some care in time, and 35.7% providing some care through direct expenditures. A positive relationship was found between participation in informal care-giving and the perception by the network member that patient needs were not being met by professionals. The decision to provide informal care was also found to be sensitive to the level of informal and formal care received by the patient. Care-giving in expense was found to be positively related to the care-giving decisions of other informal care-givers, but care-giving in time was not. Network members were more likely to provide care in time for patients who had been recently discharged to the community than for patients who remained in institutional settings. CONCLUSIONS: These results suggest the transfer of persons with severe mental illnesses from state hospitals to the community may shift the care burden between formal and informal providers. If this is the case, discharge criteria should include such factors as the community resources available to the patient. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The responsiveness of network members to perceived unmet need bespeaks the importance of informa","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 2","pages":"77-87"},"PeriodicalIF":1.6,"publicationDate":"1998-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199807)1:2<77::AID-MHP10>3.0.CO;2-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72126072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interactions between use of and insurance for specialty ambulatory mental health services","authors":"Marc P. Freiman","doi":"10.1002/(SICI)1099-176X(1998100)1:3<119::AID-MHP14>3.0.CO;2-2","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(1998100)1:3<119::AID-MHP14>3.0.CO;2-2","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: There is continuing interest in the effects of coinsurance rates on the use of ambulatory mental health services. Persons who expect to use mental health services may choose coverage with more generous mental health benefits, as such treatment may be expected to be a recurring activity. However, it may also be the case that if the expected need for such services is somehow reflected in lower perceived human capital in the labor market, then persons who have a higher probability of use may face a less generous set of health insurance options. These behaviors imply some simultaneity in the determinants of the coinsurance rate facing an individual and their mental health use.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Aim of the study&lt;/b&gt;: To explore the joint determination of the use of and coinsurance for ambulatory mental health services, using non-experimental data for a nationally representative sample of the non-institutionalized who had employer-based health insurance in the United States.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods&lt;/b&gt;: I estimate an instrument for the ambulatory mental health coinsurance rate. I then estimate two models of the demand for ambulatory mental health care as a function of the coinsurance rate for this type of care and other factors, one using the actual coinsurance rate and the other using the estimated instrument for the coinsurance rate.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results&lt;/b&gt;: In the instrumental equation, an index of the mental distress of the key worker most likely to be the policy-holder has no statistically significant effect on the worker’s coinsurance rate. However, a similar measure for other members of the worker’s family has a positive and statistically significant effect on the worker’s coinsurance rate. In the demand equations, neither the actual coinsurance rate nor its instrument has a statistically significant coefficient.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Discussion&lt;/b&gt;: Having another family member who may need mental health care results in some effort to seek a health plan with a higher coinsurance rate for such services. While the mental health index for the key worker would motivate the same type of seeking behavior, a higher level for this index for the key worker might also be correlated with a lower level of perceived human capital in a prospective employer’s eyes, and this might result in a more restricted set of plan options for mental health care in the labor market. The absence of statistical significant for the coefficients of the actual coinsurance rate and its instrument also provides some limited but suggestive evidence of employer-side selection effects.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Limitations&lt;/b&gt;: It was not possible to model the full complexity of health plans.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusions&lt;/b&gt;: The discussions of selection bias with regard to mental health insurance and service use should be expanded to include demand-side effects in the labor market, in addition to the supply-side effects on the part of workers that are often considered.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Implications for health care provisio","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 3","pages":"119-127"},"PeriodicalIF":1.6,"publicationDate":"1998-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72132711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health and substance abuse parity: a case study of Ohio’s state employee program","authors":"Roland Sturm,&nbsp;William Goldman,&nbsp;Joyce Mcculloch","doi":"10.1002/(SICI)1099-176X(1998100)1:3<129::AID-MHP16>3.0.CO;2-U","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(1998100)1:3<129::AID-MHP16>3.0.CO;2-U","url":null,"abstract":"BACKGROUND: In the United States, insurance benefits for treating alcohol, drug abuse and mental health (ADM) problems have been much more limited than medical care benefits. To change that situation, more than 30 states were considering legislation that requires equal benefits for ADM and medical care (\"parity\") in the past year. Uncertainty about the cost consequences of such proposed legislation remains a major stumbling block. There has been no information about the actual experience of implementing parity benefits under managed care or the effects on access to care and utilization. AIMS OF THE STUDY: Document the experience of the State of Ohio with adopting full parity for ADM care for its state employee program under managed care. Ohio provides an unusually long time series with seven years of managed behavioral health benefits, which allows us to study inflationary trends in a plan with unlimited ADM benefits. METHODS: Primarily a case study, we describe the implementation of the program and track utilization, and costs of ADM care from 1989 to 1997. We use a variety of administrative and claims data and reports provided by United Behavioral Health and the state of Ohio. The analysis of the utilization and cost effect of parity and managed care is pre-post, with a multiyear follow-up period. RESULTS: The switch from unmanaged indemnity care to managed carve-out care was followed by a 75% drop in inpatient days and a 40% drop in outpatient visits per 1000 members, despite the simultaneous increase in benefits. The subsequent years saw a continuous decline in inpatient days and an increased use of intermediate services, such as residential care and intensive outpatient care. The number of outpatient visits stabilized in the range of 500-550 visits per 1000. There was no indication that costs started to increase during the study period; instead, costs continued to decline. A somewhat different picture emerges when comparing utilization under HMOs with utilization under a carve-out with expanded benefits. In that case, the expansion of benefits led to a significant jump in outpatient utilization and intermediate services, while there was a small decrease in inpatient days. Insurance payments in 1996/1997 were almost identical to the estimated costs under HMOs in 1993. CONCLUSIONS: In contrast to the emerging inflation anxiety regarding overall health care costs, managed care can provide long-run cost containment for ADM care even when patient copayments are reduced and coverage limits are lifted. This may differentiate ADM care from medical care and reasons for this difference include the state of management techniques (more advanced for ADM care), complexity of treatments (much higher technology utilization in medical care) and demographic factors (medical, but not behavioral health, costs increase as the population ages). IMPLICATIONS FOR HEALTH POLICY: The experience of the state of Ohio demonstrates that parity level benefits for ADM care","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 3","pages":"129-134"},"PeriodicalIF":1.6,"publicationDate":"1998-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72137375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The economic benefits of supported employment for persons with mental illness","authors":"Robin E. Clark,&nbsp;Bradley J. Dain,&nbsp;Haiyi Xie,&nbsp;Deborah R. Becker,&nbsp;Robert E. Drake","doi":"10.1002/(SICI)1099-176X(199807)1:2<63::AID-MHP8>3.0.CO;2-2","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199807)1:2<63::AID-MHP8>3.0.CO;2-2","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: Policies and programs that emphasize employment for persons with mental illness are often promoted with the goals of improving economic self-sufficiency and reducing dependence on public welfare programs. At present, there is little empirical evidence about the actual effect of vocational interventions on economic self-sufficiency or on use of public benefits by persons with mental illness.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Study Aims&lt;/b&gt;: This study provides a preliminary look at how participating in supported employment, a form of vocational rehabilitation emphasizing ongoing support in competitive jobs, affects the amount that participants earn from work and the total amount of income they receive from all sources. Further, we examine the extent to which receiving public benefits affects the amount earned from private employment, taking into consideration other factors that might be associated with benefit status.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods&lt;/b&gt;: Data are from a randomized trial of supported employment interventions. This analysis followed 137 of those study participants with severe mental illness for 18 months after they enrolled in either of two supported employment programs. Income from various sources was estimated based on interviews with study participants upon study entry and at six-month intervals thereafter. Changes in income from work, government and other sources were analyzed using paired Wilcoxon matched-pairs signed-ranks tests and &lt;i&gt;t&lt;/i&gt;-tests. Using ordinary least-squares regression, we analyzed the effect of benefit status on changes in earnings, taking into account diagnosis, work history, education, program type, site of program, psychiatric symptoms, global functioning and previous earnings.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results&lt;/b&gt;: Estimated total income increased by an average of $134 (US) per month after enrolling in supported employment. More than three-quarters of this increase was from government sources, such as Social Security and educational grants. The increase in government income was largely due to participants applying for and getting cash benefits for the first time. Social Security payments for those receiving benefits before enrollment did not change significantly. A small group of persons (&lt;i&gt;n&lt;/i&gt; = 22) who did not receive Social Security benefits before or after enrolment earned significantly more from competitive employment after enrolling than did those who received benefits. This finding persisted after taking into acount differences in work history, clinical and functional variables and education.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Limitations&lt;/b&gt;: Because of the relatively small sample size and the lack of continuous measures of income these results should be considered preliminary.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusions&lt;/b&gt;: Supported employment, one of the more effective forms of vocational rehabilitation for persons with mental illness, did not reduce dependence on government support. Receiving government benefits was associated with lower earnings from work.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Imp","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 2","pages":"63-71"},"PeriodicalIF":1.6,"publicationDate":"1998-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199807)1:2<63::AID-MHP8>3.0.CO;2-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72126073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economics and ethics in mental health care: traditions and trade-offs","authors":"Daniel Chisholm,&nbsp;Alan Stewart","doi":"10.1002/(SICI)1099-176X(199807)1:2<55::AID-MHP11>3.0.CO;2-A","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199807)1:2<55::AID-MHP11>3.0.CO;2-A","url":null,"abstract":"<p><b>Background</b>: Both economic and ethical perspectives are exerting increasing influence at all levels of mental health policy and practice; yet there is little consensus on how these two different perspectives are to be reconciled or explicitly incorporated into decision-making.</p><p><b>Aim</b>: This review article is directed towards a fuller understanding of the complex trade-offs and compromises that are or may be made by clinicians, managers and policy-makers alike in the context of mental health care planning and delivery.</p><p><b>Method</b>: We briefly outline a number of key principles of health care economics and ethics, and then focus on the particular incentives and trade-offs that are raised by these principles at three levels of the mental health system: government and society; purchasers and providers; and users and carers.</p><p><b>Results</b>: At the level of government and society, we find (economically influenced) attempts to reform mental health care offset by concerns revolving around access to care: whether society is prepared to forgo economic benefits in exchange for improved equity depends to a considerable extent on the prevailing ethical paradigm. The implementation of these reforms at the level of purchasers and providers has helped to focus attention on evaluation and prioritization, but has also introduced ‘perverse incentives’ such as cost-shifting and cream-skimming, which can impede access to or continuity of appropriate care for mentally ill people. Finally, we detect opportunities for moral hazard and other forms of strategic behaviour that are thrown up by the nature of the carer:user relationship in mental health care.</p><p><b>Conclusion</b>: We conclude by highlighting the need to move towards a more open, accountable and evidence-based mental health care system. Acknowledgement of and progress towards these three requirements will not deliver <i>ideal</i> levels of efficiency or equity, but will foster a greater understanding of the relevance of ethical considerations to mental health policies and strategies that are often influenced strongly or solely by economic arguments, whilst also demonstrating that equity must come at a price. © 1998 John Wiley &amp; Sons, Ltd.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 2","pages":"55-62"},"PeriodicalIF":1.6,"publicationDate":"1998-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199807)1:2<55::AID-MHP11>3.0.CO;2-A","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72137437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts translations (Russian)","authors":"Ella Rytik Dr","doi":"10.1002/(SICI)1099-176X(199807)1:2<101::AID-MHP13>3.0.CO;2-V","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199807)1:2<101::AID-MHP13>3.0.CO;2-V","url":null,"abstract":"<p>See PDF file</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 2","pages":"101-104"},"PeriodicalIF":1.6,"publicationDate":"1998-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199807)1:2<101::AID-MHP13>3.0.CO;2-V","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72137434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts translations","authors":"","doi":"10.1002/(SICI)1099-176X(1998100)1:3<147::AID-MHP19>3.0.CO;2-H","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(1998100)1:3<147::AID-MHP19>3.0.CO;2-H","url":null,"abstract":"<p>See PDF file for the Russian abstract translations</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 3","pages":"147-149"},"PeriodicalIF":1.6,"publicationDate":"1998-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72137665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost benefits of substance abuse treatment: an overview of results from alcohol and drug abuse","authors":"Harold D. Holder Ph.D.","doi":"10.1002/(SICI)1099-176X(199803)1:1<23::AID-MHP3>3.0.CO;2-Q","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199803)1:1<23::AID-MHP3>3.0.CO;2-Q","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Background and Methods&lt;/b&gt;: The treatment of substance abuse is an important health service available in all industrialized countries throughout the world. Cost of treatment and its benefit or economic value is an important policy issue. Reduction in health care cost is one alternative way to measure benefits. This paper reviews a series of studies (all from the US) which address the cost–benefit question. Most studies have compared the monthly costs prior to initiation of substance abuse treatment with the costs following initiation.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results from Studies of Alcoholism Treatment&lt;/b&gt;: Many studies have found that, over the time prior to alcoholism treatment initiation, total monthly health care costs increased and costs substantially increased during the 6–12 months prior to treatment. Following treatment initiation, monthly total medical care costs declined and the overall trend was downward, i.e., the slope was negative. In contrast to the use of general health care where women typically utilize more medical care than men, overall medical care costs were found to be similar. Alcoholics of different ages, however, showed distinct medical care costs, i.e., younger patients experienced greater declines in medical care costs following alcoholism treatment initiation.&lt;/p&gt;&lt;p&gt;Inpatient treatment is most affected by alcoholism treatment. In some cases, outpatient treatment is actually increased in response to aftercare health care utilization, but at a substantially lower cost than inpatient treatment. If the alcoholism condition can be treated on an outpatient basis, then the total cost of such treatment is obviously lower and the potential for a cost–offset net effect is substantially increased.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Cost Benefits of Drug Abuse Treatment&lt;/b&gt;: There have been few drug abuse treatment cost-benefit research studies. Early studies found that there was a decline in sickness and medical care utilization associated with initiation of treatment. A recent study found a substantial reduction in total health care costs following initiation of drug abuse treatment. Utilization of inpatient care and its associated costs are most affected by the absence and/or presence of treatment.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Summary and Conclusion&lt;/b&gt;: This review describes the research findings from a number of cost-offset or cost-benefit studies of alcoholism and drug abuse treatment. In broad terms the findings of this research can be summarized as follows.&lt;/p&gt;&lt;p&gt;(i) Untreated alcoholics or drug dependent persons use health care and incur costs at a rate about twice that of their age and gender cohorts. (ii) Once treatment begins, total health care utilization and costs begin to drop, reaching a level that is lower than pre-treatment initiation costs after a two- to four-year period. The conclusion is based on similar findings across different patient populations using a variety of research designs. (iii) There are no apparent gender differences in the utilization and associat","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 1","pages":"23-29"},"PeriodicalIF":1.6,"publicationDate":"1998-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199803)1:1<23::AID-MHP3>3.0.CO;2-Q","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72137498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}