Journal of Mental Health Policy and Economics最新文献

{"title":"Characteristics and Healthcare Burden of Patients with Schizophrenia Treated in a US Integrated Healthcare System.","authors":"Rohan Mahabaleshwarkar, Dee Lin, Kruti Joshi, Jesse Fishman, Todd Blair, Timothy Hetherington, Pooja Palmer, Charmi Patel, Constance Krull, Oleg V Tcheremissine","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Schizophrenia is one of 15 major causes of disability worldwide and is responsible for more than USD 150 billion in annual healthcare costs in the United States. Although the burden of schizophrenia as measured by healthcare resource utilization (HRU) is known to be considerable, data generally come from claims databases or healthcare systems/payors representing only a subset of patients, such as Medicare/Medicaid recipients. A broader understanding of HRU across the schizophrenia patient population would help identify underserved groups and inform strategies for improving healthcare delivery.</p><p><strong>Aims of the study: </strong>This observational study examined overall HRU and the influence of sociodemographic factors in adult patients with schizophrenia receiving care in a US integrated healthcare system.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data from electronic medical records (EMRs). Patients were required to have at least two diagnostic codes for schizophrenia recorded in the EMR within a 12-month period from January 2009 to June 2018, and to have received active care (≥ 1 in-system healthcare visit every six months) for at least 12 months before and after the index date (the earlier of the schizophrenia diagnosis dates). Patients were followed until no longer receiving active care or the end of the study. Patient characteristics were assessed during the 12-month pre-index period, and inpatient, readmission, emergency room (ER), and outpatient visits and antipsychotic prescriptions were described during follow-up. Findings were reported overall and in subgroups by race/ethnicity, age, and sex.</p><p><strong>Results: </strong>The study cohort included 2,941 patients (mean age, 48.3 years; 54.5% male, 51.8% black, 45.8% with Medicare). During the follow-up period (mean, 4.6 years), inpatient hospital stays were common, with at least one all-cause, mental health-related, or schizophrenia-related inpatient visit occurring for 48.7%, 47.3%, and 38.8% of patients, respectively. Hospital readmissions within 30 days of an all-cause inpatient visit occurred in 20.4% of patients, with 14.5% of patients readmitted within 30 days of a schizophrenia-related inpatient visit. More than two-thirds of patients had ER visits, and 40.7% had schizophrenia-related ER visits. Only 46.7% of patients with a schizophrenia-related inpatient visit and 58.5% of patients with a mental health-related inpatient visit had a 30-day outpatient follow-up visit. Subgroup analyses revealed that a larger proportion of non-Hispanic black vs non-Hispanic white patients had 30-day outpatient follow-up visits, ER visits, mental health specialist visits, and antipsychotic prescriptions. Moreover, older age was associated with fewer ER and mental health specialist visits and less use of injectable and second-generation antipsychotics, and women were less likely than men to receive antipsychotic therapy, ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 2","pages":"47-59"},"PeriodicalIF":1.6,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39252915","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":"Farmer Suicides: Effects of Socio-Economic, Climate, and Mental Health Factors.","authors":"Suzan Odabasi,&nbsp;Valentina Hartarska","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>People working in agriculture, fishing, and forestry have elevated risks of suicide. The suicide rates for the occupations of \"agriculture, fishing, and forestry\" are significantly higher than any other occupation.</p><p><strong>Aims of study: </strong>This study evaluates whether the variability in socioeconomic and demographic factors and in climate as well as the support from mental health providers and social associations affected the suicide rates of farmers in the US.</p><p><strong>Methods: </strong>We estimate Poisson count data regression and county level-fixed effects regressions using data from the National Center for Health Statistics complemented with relevant socio-economic, climate data and data on mental health providers from a variety of sources.</p><p><strong>Results: </strong>The results show more suicides in counties with more farms and with higher share of population without health insurance, lower agricultural wages and, in non-rural counties higher poverty rate. Surprisingly, we find more suicides in counties with more social associations, while the availability of mental health providers is associated with fewer suicides in non-rural counties, and lower suicide rate in southern counties.</p><p><strong>Discussion: </strong>These results highlight the need for innovative targeted policy interventions instead of relying on one-size-fits-all approach. Farmers and farm workers are yet to be reached with modern and effective tools to improve mental health and prevent suicide. At the same time, factors such as the weather and climate as well as some more traditional factors such as social associations or religious participation play a limited role.</p><p><strong>Implications for health policies: </strong>Support mechanisms have a differential effect in rural and urban areas. It is important to identify the specific demographic, climate, and policy changes that serve as external stressors and affect farm workers' suicide and accidental death from on-farm injury.</p><p><strong>Implication for further research: </strong>Ideally, individual level data on farmers would be best in a study that evaluates what factors cause suicides.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 2","pages":"61-71"},"PeriodicalIF":1.6,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39251781","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":"Costs of Health Service Use among Unemployed and Underemployed People with Mental Health Problems.","authors":"Tamara Waldmann,&nbsp;Tobias Staiger,&nbsp;Nicolas Ruesch,&nbsp;Reinhold Kilian","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Unemployment is associated with a high risk of experiencing mental illness. This can lead to stigmatisation, reduced quality of life, and long-term costs like increased healthcare expenditure and productivity losses for society as a whole. Previous research indicates evidence for an association between unemployment and higher mental health service costs, but there is insufficient information available for the German healthcare system.</p><p><strong>Aim of the study: </strong>This study aims to identify costs and cost drivers for health and social service use among unemployed people with mental health problems in Germany.</p><p><strong>Methods: </strong>A sample of 270 persons participated at baseline and six-month-follow-up. Healthcare and social service use was assessed using the Client Socio-Demographic and Service Receipt Inventory. Descriptive cost analysis was performed. Associations between costs and potential cost drivers were tested using structural equation modelling.</p><p><strong>Results: </strong>Direct mean costs for 12 months range from EUR 1265.13 (somatic costs) to EUR 2206.38 (psychiatric costs) to EUR 3020.70 (total costs) per person. Path coefficients indicate direct positive effects from the latent variable mental health burden (MHB) on stigma stress, somatic symptoms, and sick leave.</p><p><strong>Discussion: </strong>The hypothesis that unemployed people with mental health problems seek help for somatic symptoms rather than psychiatric symptoms was not supported. Associations between MHB and costs strongly mediated by sick leave indicate a central function of healthcare provision as being confirmation of the inability to work.</p><p><strong>Implications for health policies: </strong>Targeted interventions to ensure early help-seeking and reduce stigma remain of key importance in reducing long-term societal costs.</p><p><strong>Implications for further research: </strong>Future research should explore attitudes regarding effective treatment for the target group.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 1","pages":"31-41"},"PeriodicalIF":1.6,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25495048","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":"Psychiatric Emergencies Following the 2008 Economic Recession: An Ecological Examination of Population-Level Responses in Four US States.","authors":"Parvati Singh","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Research examining mental health outcomes following economic downturns finds both pro-cyclic and counter-cyclic associations. Pro-cyclic findings (i.e. economic downturns correspond with decline in illnesses) invoke increase in leisure time and risk-averse behavior as underlying drivers of reduction in harmful consumption during economic recessions. By contrast, counter-cyclic evidence (i.e. economic downturns correspond with increase in illnesses) suggests increase in mental illness with economic decline owing to heightened stress and loss of resources, particularly among certain age and socioeconomic groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim of the study: &lt;/strong&gt;To examine the relation between monthly aggregate employment decline and psychiatric emergency department visits across 96 counties within 49 Metropolitan Statistical Areas in the United States.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;For this study, data on all psychiatric outpatient Emergency Department (ED) visits for 4 US states (Arizona, California, New Jersey and New York) were retrieved from the State Emergency Department Database (SEDD) and aggregated by county-month, for the time period of 2006 to 2011. Exposure to recession was operationalized as population-level employment change in a Metropolitan Statistical Area (MSA). This information was obtained from MSA-level employment provided by the US Bureau of Labor Statistics. Brief exposure time lags of 0 to 3 months were specified to estimate proximate responses to MSA-level economic decline. Income level was approximated based on insurance status (private insurance= high-income, public insurance = low-income). Linear regression analysis was used to test whether monthly decline in aggregate employment in an MSA corresponds with (i) changes in population rates of psychiatric ED visits and (ii) whether the relation between the outcome and exposure varies by insurance status (private, public) and age group (children, age &lt; 20 years; working-age adults, age 20 to 64 years; elderly adults, age &gt; 64 years). Regression methods controlled for region, year and month fixed effects, and state-specific linear time trends.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Linear regression results indicate that overall, psychiatric ED visits (per 100,000 population) decline with decline in monthly employment at exposure lag 0 (coefficient: 0.54, p &lt; 0.001) and lag 2 (coefficient: 0.52, p &lt; 0.001). Privately insured (high-income) groups also show a decline in psychiatric ED visits following decline in aggregate employment. Conversely, publicly insured children show an increase in psychiatric ED visit rates one month (i.e. lag 1) following employment decline (coefficient: -0.35, p value &lt; 0.01). Exploratory analyses by disorder groups show that the population-level decline in psychiatric ED visits concentrates among visits for alcohol use disorders at 0, 1 and 2 month lags of employment decline.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;This study's findings","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 1","pages":"13-30"},"PeriodicalIF":1.6,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25495047","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":"Drug Expenditure, Price, and Utilization in the U.S. Medicaid: A Trend Analysis for SSRI and SNRI Antidepressants from 1991 to 2018.","authors":"Marwan Alrasheed,&nbsp;Ana L Hincapie,&nbsp;Jeff J Guo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>SSRIs and SNRIs are antidepressants that have largely substituted old antidepressants like Monoamine Oxidase Inhibitors (MAOIs) and Tricyclic Antidepressants (TCAs). They have been widely used since 1987 when the FDA approved the first SSRI Fluoxetine and the first SNRI Venlafaxine in 1993. Since then, several new SSRIs and SNRIs have been approved and entered the market. Utilization, pricing, and spending trends of SSRIs and SNRIs have not been analyzed yet in Medicaid.</p><p><strong>Aim: </strong>To assess the trends of drug expenditure, utilization, and price of SSRI and SNRI antidepressants in the US Medicaid program, and to highlight the market share of SSRIs and SNRIs and the effect of generic drug entry on Medicaid drug expenditure.</p><p><strong>Methods: </strong>A retrospective descriptive data analysis was conducted for this study. National pharmacy summary data for study brand and generic drugs were retrieved from the Medicaid State Outpatient Drug Utilization Data. These data were collected by the US Centers for Medicare and Medicaid Services (CMS). The study period was between 1991 and 2018. Study drugs include 12 different SSRI and SNRI brands and their generics available in the market, such as citalopram, escitalopram, paroxetine, fluoxetine, sertraline, venlafaxine, desvenlafaxine, duloxetine, and levomilnacipran. Data were analyzed annually and categorized by total prescriptions (utilization), total reimbursement (spending), and cost per prescription as the proxy of the price for each drug.</p><p><strong>Results: </strong>From 1991 to 2018, total prescriptions of SSRI and SNRI drugs rose by 3001%. Total Medicaid spending on SSRIs and SNRIs increased from USD 64.5 million to USD 2 billion in 2004, then decreased steadily until it reached USD 755 million in 2018. The SSRIs average utilization market share was 87% compared to 13% of the SNRIs utilization market share. About 72% of total Medicaid spending on the two groups goes to SSRIs, while the remaining 28% goes to SNRIs. Brand SSRIs and SNRIs prices increased over time. On the contrary, generic drugs prices steadily decreased over time.</p><p><strong>Discussion: </strong>An increase in utilization and spending for both SSRI and SNRI drugs was observed. After each generic drug entered the market, utilization shifted from the brand name to the respective generic due to their lower price. These generic substitutions demonstrate a meaningful cost-containment policy for Medicaid programs.</p><p><strong>Implications for health policies: </strong>Our findings show the overall view of Medicaid expenditure on one of the most commonly prescribed drug classes in the US. They also provide an important insight toward the antidepressant market and the importance of monitoring different drugs and their alternatives.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"24 1","pages":"3-11"},"PeriodicalIF":1.6,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25495111","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":"Medicaid Expansion and Health Insurance Coverage and Treatment Utilization among Individuals with a Mental Health Condition.","authors":"Samuel H Zuvekas,&nbsp;Chandler B McClellan,&nbsp;Mir M Ali,&nbsp;Ryan Mutter","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Affordable Care Act (ACA) gives states the option of expanding Medicaid coverage to low-income individuals; however, not all states have chosen to expand Medicaid. The ACA Medicaid expansions are particularly important for Americans with mental health conditions because they are substantially more likely than other Americans to have low incomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;We examine the impact of Medicaid expansion on adults who were newly eligible for Medicaid using the 2008-2017 Medical Expenditure Panel Survey (MEPS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We use the AHRQ PUBSIM model to identify low-income adults aged 19-64 who were either newly Medicaid eligible if they lived in an expansion state or would have been eligible had their state opted to expand its Medicaid program. We estimate linear probability models within a difference-in-difference framework. An additional interaction term allows us to test for differences among those with serious psychological distress (SPD) or probable depression (PD). Outcomes of interest are insurance coverage by type, behavioral health treatment by service (specifically, any behavioral health treatment, any specialty treatment, any psychotropic medication, any ambulatory treatment outside of an emergency department, and any emergency department treatment), quantities of behavioral health treatment services, and out of pocket spending on healthcare.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our adjusted difference-in-differences estimates indicate Medicaid expansion increased any insurance coverage by 14.2 percentage points and increased Medicaid coverage by 21.2 percentage points. Insurance coverage for individuals with SPD/PD in expansion states increased by an additional 12.9 percentage points. Medicaid expansion did not have an effect on behavioral health treatment for the newly eligible population as a whole or for the subset with SPD/PD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Consistent with previous Medicaid expansions, we find that the ACA Medicaid expansions substantially increased insurance rates for the newly Medicaid-eligible population, regardless of mental health status but the overall effect on insurance coverage was stronger among those with SPD/PD. The lack of an effect on treatment use suggests that providing insurance coverage alone may be insufficient to guarantee that people with mental illness will receive the treatment they need. Limitations include that our difference-in-difference estimator may not account for time-varying factors that change contemporaneously with the expansions. Our estimates may also be affected by other provisions of the ACA that went into effect at the same time as the Medicaid expansions. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE AND IMPLICATIONS FOR HEALTH POLICIES: Although the ACA has resulted in increased coverage for low-income individuals, more outreach efforts may be needed to encourage individuals with mental illne","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"23 3","pages":"151-182"},"PeriodicalIF":1.6,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38791489","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":"Psychological Distress and Coronavirus Fears During the Initial Phase of the COVID-19 Pandemic in the United States.","authors":"Michael T French,&nbsp;Karoline Mortensen,&nbsp;Andrew R Timming","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic is a significant health and economic crisis around the world. The U.S. saw a rapid escalation in laboratory-confirmed cases of COVID-19 and related deaths in March, 2020. The financial consequences of a virtual economic shutdown to curb the spread of the coronavirus are widespread and debilitating, with over 30 million Americans (about 20% of the labor force) filing for unemployment benefits since mid-March. During these unprecedented times, it is important to understand the impact of the COVID-19 pandemic on psychological distress and overall fear associated with the virus.</p><p><strong>Data: </strong>To gain an understanding of the overall levels and predictors of psychological distress experienced in the first month of the COVID-19 pandemic in the U.S., a survey was administered online to over 2,000 individuals residing in the country. The survey instrument was administered between March 22-26, 2020, during which time the country was suffering through a period of exponential growth in COVID-19 cases and fatalities. It was administered via MTurk, a popular crowdsourcing platform increasingly used by social scientists to procure large samples over a brief period of time. A short, valid screening instrument to measure psychological distress in individuals, the Kessler 10 scale was developed in the U.S. in the 1990s as an easy-to-administer symptom assessment. The first dependent variable is the respondents' summated Kessler 10 score. The second dependent variable is a 7-category measure of how afraid the subject is about the novel coronavirus. The final dependent variable is also a 7-category scale, this time measuring self-reported likelihood of contracting the coronavirus. A variety of socio-demographic variables and health status were collected to analyze factors associated with psychological distress and mental health.</p><p><strong>Methods: </strong>Ordinary Least Squares (OLS) multiple regression was employed to analyze these data.</p><p><strong>Results: </strong>We find that protective factors against psychological distress include age, gender (male), and physical health. Factors exacerbating psychological distress include Hispanic ethnicity and a previous mental illness diagnosis. Similar factors are significantly related to fear of the virus and self-assessed likelihood of contracting it.</p><p><strong>Discussion: </strong>The COVID-19 pandemic is associated with high levels of psychological distress in the U.S. The Kessler 10 mean value in our sample is 21.12, which falls in the likely to experience mild mental illness category, yet is considerably higher compared to one of the largest and earliest benchmark studies validating the scale. Psychological distress is one element of overall mental health status that could be influenced by the COVID-10 pandemic. Other mental health conditions such as depression, anxiety, and substance use disorders could also be affected by the pandemic","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"23 3","pages":"93-100"},"PeriodicalIF":1.6,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38316182","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":"Putting Providers At-Risk through Capitation or Shared Savings: How Strong are Incentives for Upcoding and Treatment Changes?","authors":"Marisa Elena Domino,&nbsp;Edward C Norton,&nbsp;Jangho Yoon,&nbsp;Gary S Cuddeback,&nbsp;Joseph P Morrissey","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Alternative payment models, including Accountable Care Organizations and fully capitated models, change incentives for treatment over fee-for-service models and are widely used in a variety of settings. The level of payment may affect the assignment to a payment category, but to date the upcoding literature has been motivated largely incorporating financial penalties for upcoding rather than by a theoretical model that incorporates the downstream effects of upcoding on service provision requirements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;In this paper, we contribute to the literature on upcoding by developing a new theoretical model that is applicable to capitated, case-rate and shared savings payment systems. This model incorporates the downstream effects of upcoding on service provision requirements rather than just the avoidance of penalties. This difference is important especially for shared-savings models with quality benchmarks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We test implications of our theoretical model on changes in severity determination and service use associated with changes in case-rate payments in a publicly-funded mental health care system. We model provider-assigned severity categories as a function of risk-adjusted capitated payments using conditional logit regressions and counts of service days per month using negative binomial models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We find that severity determination is only weakly associated with the payment rate, with relatively small upcoding effects, but that level of use shows a greater degree of association.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;These results are consistent with our theoretical predictions where the marginal utility of savings or profit is small, as would be expected from public sector agencies. Upcoding did seem to occur, but at very small levels and may have been mitigated after the county and providers had some experience with the new system. The association between the payment levels and the number of service days in a month, however, was significant in the first period, and potentially at a clinically important level. Limitations include data from a single county/multiple provider system and potential unmeasured confounding during the post-implementation period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;Providers in our data were not at risk for inpatient services but decreases in use of outpatient services associated with rate decreases may lead to further increases in inpatient use and therefore expenditures over time.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;Health program directors and policy makers need to be acutely aware of the interplay between provider payments and patient care and eventual health and mental health outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for further research: &lt;/strong&gt;Further research could examine the implications of the theoretical model of upcoding in other paymen","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"23 3","pages":"81-91"},"PeriodicalIF":1.6,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38316181","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":"Return on Investment of the Primary Health Care Integrated Geriatric Services Initiative Implementation.","authors":"Nguyen X Thanh,&nbsp;Tanmay Patil,&nbsp;Charlene Knudsen,&nbsp;Sharon N Hamlin,&nbsp;Helen Lightfoot,&nbsp;Heather M Hanson,&nbsp;Dennis Cleaver,&nbsp;Karenn Chan,&nbsp;James Silvius,&nbsp;Scott Oddie,&nbsp;Scott Fielding","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Since June 2017, the Primary Health Care Integrated Geriatric Services Initiative (PHC IGSI) has been implemented in Alberta, Canada to, among other aims, reduce costs of unplanned health service utilization while maximizing the utilization of available community resources to support people living with dementia living in communities.</p><p><strong>Aim of the study: </strong>We performed an economic evaluation of this initiative to inform policy regarding sustainability, scale up and spread.</p><p><strong>Methods: </strong>We used a cohort design together with a difference-in-difference approach and a propensity score matching technique to calculate impacts of the intervention on patient's health service utilization, including inpatient, outpatient and physician services, as well as prescription drugs. We then used a decision tree to compare between benefits and costs of the intervention and reported net benefits (NB) and return on investment ratios (ROI). We used a health system perspective and a time horizon of 1 year. Both deterministic and probabilistic sensitivity analyses were performed for the uncertainty of parameters. We analyzed real-world data extracted from the Alberta Health Administrative Databases. All costs/savings were inflated to 2019 CAD (CAD 1 sim = USD 0.75) using the Canadian Consumer Price Index.</p><p><strong>Results: </strong>The intervention reduced the use of hospital (inpatient, emergency, and outpatient) services by increasing the use of community services (physician and prescription drug). As hospital services are expensive, the PHC IGSI community intervention resulted in a NB from CAD 554 to 4,046 per patient-year for the health system, and a ROI from 1.3 to 3.1 meaning that every CAD invested in PHC IGSI would bring CAD 1.3 to 3.1 in return. The probability of PHC IGSI to be cost-saving was 56.4% to 69.3%.</p><p><strong>Implications for health care provision and use: </strong>The PHC IGSI is cost-effective in Alberta.</p><p><strong>Implications for health policy: </strong>The savings would be larger if the initiative is sustained, scaled up and spread because of not only a reduced cost of intervention in the sustainability phase, but also because of the increased number of patients that would be impacted.</p><p><strong>Implications for further research: </strong>Future studies taking a societal perspective to also include costs for families and health and social sectors at the community level, would be desirable. Additionally, future works to determine how wellbeing is impacted by the PHC IGSI as vertical and horizontal integration interventions are implemented at the community level, are essential to undertake. Finally, in addition to people living with dementia, the PHC IGSI also supports people living in the community with frailty and other geriatric syndromes, therefore, the cost-savings estimated in this study are likely underestimated.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"23 3","pages":"101-109"},"PeriodicalIF":1.6,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38316183","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":"Estimation of the Social Costs of Illegal Drug Use in Poland Using Standardized Methodology.","authors":"Zofia J Mielecka-Kubie","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Illegal drug use causes a variety of negative consequences for the society -- referred to as the social costs of illegal drug use -- and therefore they are estimated in many countries. The main purpose of social cost estimation is prevention or, at least, attenuation of the negative effects of illegal drug use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of study: &lt;/strong&gt;The main aim of the study was the estimation of the basic social costs of illegal drug use in Poland in the year 2015 with the use of standardized methodology and the standardized presentation of results, which can ensure better comparison of the costs between countries. The other aim of the study was to present a method to fill the gaps in statistical data concerning the criminal justice system costs attributable to illegal drugs use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;Cost-of-illness (COI), human capital, and prevalence-based approaches were applied to costs estimation. The author proposed a method combining survey results with official statistical data, which allows for rough estimation of some of the criminal justice costs. Furthermore, the method for and the results of the estimation of mortality rates for drug users and non-users and their life expectation were presented.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The results indicate that the total direct costs of illegal drug use in Poland in the year 2015 expressed in monetary terms amounted to EUR 135.67m, which constituted about 0.03% of Poland's GDP in 2015. The highest costs were incurred by the criminal justice system (EUR 74.05m) and the health care system (EUR 44.42m). Estimated productivity costs attributable to premature mortality of illegal drug users and their absenteeism were equal to EUR 18.42m. The mortality rates of drug users were much higher than those of non-users. The users could lose, on average, over 12 years of their expected life (men), and over 8 years (women).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The social cost estimation performed in the study covers only basic costs and could be expanded in many ways. For several reasons, the estimated costs represent only the lower limit of the social costs of illegal drug use in Poland in 2015. Whenever it was possible the data were obtained from official statistical sources, but some information came from surveys, burdened with their usual weaknesses. In spite of certain shortcomings of statistical data, the use of standardized methodology and the standardized presentation of the results could ensure better comparison of the costs and their distribution between countries, which is especially needed in the EU countries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;The knowledge of the levels and distribution of the social costs of illegal drug use may help to improve health policies in individual countries as well as in the EU, especially when the costs are estimated in a similar way. Additionally, the dissemination of the information on the differences ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"23 3","pages":"139-149"},"PeriodicalIF":1.6,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38791488","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}