Journal of Mental Health Policy and Economics最新文献

{"title":"The Burden of Mental Illness and Mental Distress on Family Members.","authors":"Bing Niu, Lingling Zhang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The Organisation for Economic Cooperation and Development reports that one in every two people experiences a mental illness in their lifetime, and developed policy guidelines to address the impact of mental health-related issues on employment and health. The results of this policy initiative have been reported in many member countries but no survey findings are available yet for Japan. Previous studies in Japan focused on the social costs of mental illness, but little empirical evidence exists on burdens created by mental illness in individual households.</p><p><strong>Aims: </strong>This study investigated the effects of mental illness and mental distress on family members' employment and sleep time. Employed men and women family members and unemployed women family members who wanted to work were included in the study.</p><p><strong>Methods: </strong>Japanese survey data from the 2013 Comprehensive Survey of Living Conditions were analyzed to identify the above-mentioned effects. A propensity score matching method was used to create a valid comparison group for family members of patients with mental illness and distress.</p><p><strong>Results: </strong>For depression, family member average weekly work hours decreased by a range of 1.06 (p%lt;0.01) to 1.18 (p<0.01) for men, and 0.53 (p<0.1) to 1.06 (p<0.05) for women. For dementia (termed \"major neurocognitive disorder\" in the DSM-5), there were no statistically significant effects on work hours in men, but the work hours of employed women increased, ranging from 1.15 (p<0.05) to 1.25 (p<0.01). Mental illness in a family member also significantly influenced future employment prospects of unemployed women. In family members of patients with dementia, sleep time decreased by a range of 3.6 minutes (p<0.05) to 4.8 minutes (p<0.01) per night for men and 12 minutes (p<0.01) per night for women.</p><p><strong>Discussion and limitations: </strong>These findings can add to the existing evidence on the effects of mental illness and distress on family members' work hours and sleep time in Japan, which are consistent with research from other countries such as Germany, the UK, and the US. This study has two limitations. First, the magnitude of the effect of mental illness is limited with respect to the illness category in our study, since the severity of the condition and the impact on actual daily life may vary across categories or differ even within the same category. Second, measurement error might exist in the self-reported mental illness measures.</p><p><strong>Policy implications: </strong>First, cooperation and mutual support between employers and the community are necessary to support working family caregivers by allowing them to adjust work schedules to accommodate caregiving responsibilities. Second, social institutional policies are needed that reduce the burden of informal caregiving for family members with mental illness and increase access to long-term care for t","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"23 1","pages":"3-17"},"PeriodicalIF":1.6,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37980066","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":"PERSPECTIVES: Insurance markets, labor markets, and the mental health services delivery system.","authors":"Agnes Rupp,&nbsp;Michael C Freed,&nbsp;Denise Juliano-Bult","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The authors are health scientist administrators at the National Institute of Mental Health (NIMH). The mission of NIMH is \"to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure.\" As part of its portfolio, NIMH supports research on mental health economics, and mental health services research.</p><p><strong>Method: </strong>In this perspective article, the authors comment on two papers presented at the NIMH-sponsored Mental Health Services Research Conference in 2018 and subsequently published in the September 2019 issue of the Journal of Mental Health Policy and Economics. Two important areas are highlighted in this review: (i) the impact of insurance and labor markets on the delivery of high-quality mental health services, and (ii) the need for advancements in method development and design in future studies.</p><p><strong>Discussion: </strong>The complexity of health insurance markets created some unintended consequence of the mental health insurance parity legislation. Mental health provider shortages in local labor markets are a barrier to successful implementation and sustainment of innovative and evidence-based mental health service-delivery models for people with serious mental illness.</p><p><strong>Implications for research: </strong>Data-capture techniques that seamlessly integrate insurance claims with clinical outcomes (e.g., from electronic health records) will better equip health economists and other end-users with rigorous research findings to inform public health policy and practice recommendations. Despite early signals of success, larger sample sizes and more rigorous research designs are needed to refine predictive models of functional outcomes of evidence-based service-delivery models (e.g., coordinated specialty care model including supported education, and supported employment) for people with first-episode psychosis.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"22 4","pages":"151-154"},"PeriodicalIF":1.6,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37645344","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":"COMMENTS: Future Directions for OnTrackNY and Coordinated Specialty Care for Young People with Recent-Onset Psychosis.","authors":"Jennifer L Humensky,&nbsp;Ilana Nossel,&nbsp;Iruma Bello,&nbsp;Lisa B Dixon","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"22 4","pages":"155-157"},"PeriodicalIF":1.6,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478861/pdf/nihms-1061371.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38368132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic costs of antidepressant use: a population-based study in Sweden.","authors":"Linda Beckman,&nbsp;Laura von Kobyletzki,&nbsp;Mikael Svensson","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Prescription of antidepressant drugs (ADs) has increased in recent decades, with rising costs for patients as well as for the health care system. There is sparse evidence of which factors explain the high economic costs and financial burden for the general population.</p><p><strong>Aims of the study: </strong>The aim was to assess individual-level determinants of out-of-pocket and total health care costs of AD use in the Swedish general population.</p><p><strong>Methods: </strong>We randomly sampled 400,000 individuals aged 18+ from Statistics Sweden's population register from 2010 to 2013. Two-part regression models were used for our two primary outcome variables: (i) total health care costs for AD use per year and individual, and (ii) total out-of-pocket costs of AD use per year and individual.</p><p><strong>Results: </strong>Women, the unemployed, unmarried people and residents of big cities have both higher use of ADs and higher associated total health care and out-of-pocket costs. Today, ADs are relatively inexpensive and average cost differences among all groups are therefore minor. The elderly have higher use of ADs, but are more commonly low-volume users and do not have higher total health care or out-of-pocket costs.</p><p><strong>Discussion and limitations: </strong>Groups with relatively low socioeconomic status are at risk of higher costs for antidepressant use. However, given the Swedish system of drug subsidies, differences in financial burden for individuals are minor. The limitations of this study included that we lacked data on diagnosis and could therefore not categorize the reasons for AD consumption. Furthermore, our results may not be generalized to other countries with a lower AD prevalence then Sweden's, since our estimates are dependent on the point prevalence of antidepressant use in the population.</p><p><strong>Implications for health care provision and use: </strong>Groups with higher AD consumption and economic costs may suffer from more severe depression owing to more risk factors and less social support in their surroundings, and may be in greater need of additional treatment and support than other groups.</p><p><strong>Implications for health policies and further research: </strong>Our results offer insight at an aggregate level, and more information on the underlying causes of higher costs is needed to discern the policy implications.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"22 4","pages":"125-130"},"PeriodicalIF":1.6,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37645343","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":"Income loss and the mental health of young mothers: evidence from the recession in Ireland.","authors":"Fiona M Kiernan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>There are many potential pathways in the income health relationship. Problems arise in examining the effect of income loss primarily because of difficulties in disentangling income from the effect of the labour market, but also because of the heterogenous nature of health variables. Psychological, rather than physical, health is important because younger populations are unlikely to manifest clinical evidence of physical disease in the short term. However, biological pathways of stress indicate that this can result in increased mortality and morbidity in the longer term.</p><p><strong>Aims of the study: </strong>The study follows the example of work that has harnessed the Great Recession to examine income loss, but in contrast to previous work, this study examines the relationship of disposable income and mental health. The study exploits disposable, rather than gross, income, because of economic theory relating disposable income to consumption and research demonstrating the role of consumption in wellbeing. Data from the period of the Great Recession in Ireland allows the examination of changes in disposable income due to government policies that reduced public expenditure and increased taxation.</p><p><strong>Methods: </strong>Using three waves of panel data from the Growing Up in Ireland study a fixed effects approach is taken to examine disposable income and the mental health of the mothers of young children. A balanced panel is used which results in 6821 individuals being studied over the three waves. The primary dependent variable of interest is depression, scored using a short form of the Centre for Epidemiological Depression Scale (CES-D), although additional outcomes of interest include treatment for a mental health condition, and measures of parental stress using the Parental Stress Scale.</p><p><strong>Results: </strong>There is a statistically significant relationship between changes in depression score and disposable income loss over the three waves. This relationship is independent of labour market loss during that time. The effect of income loss is predominantly seen for those who are homeowners. Subjective reports of being in mortgage or rent arrears are also associated with an increase in depression score.</p><p><strong>Discussion: </strong>This group, comprising the mothers of young children, is particularly interesting in view of the credit constraints experienced by younger households during the financial crisis in Ireland. Both sets of results are consistent with qualitative studies which have shown that mortgage difficulties can lead to depression, anxiety and poor mental health, and that high status groups experience shame and self-blame when they experience a financial loss. It remains to be seen if this will have a long-term effect on the mental health of either the mothers or their children.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"22 4","pages":"131-149"},"PeriodicalIF":1.6,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37645468","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":"Assessing Costs Using the Treatment Inventory Cost in Psychiatric Patients (TIC-P), TIC-P Mini and TIC-P Midi.","authors":"Tim A Kanters,&nbsp;Reinier Timman,&nbsp;Moniek C Zijlstra-Vlasveld,&nbsp;Anna Muntingh,&nbsp;Klaas M Huijbregts,&nbsp;Kirsten M van Steenbergen-Weijenburg,&nbsp;Clazien A M Bouwmans,&nbsp;Christina M van der Feltz-Cornelis,&nbsp;Leona Hakkaart-van Roijen","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Treatment Inventory Cost in Psychiatric patients (TIC-P) instrument is designed to measure societal costs in patients with psychiatric disorders and to be applied in economic evaluations. Efforts have been made to minimize respondents' burden by reducing the number of questions and meanwhile retaining the comprehensiveness of the instrument. Previously, a TIC-P Mini version and a TIC-P Midi version were developed and tested in a predominantly inpatient patient population.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;The aims of this study are to examine the comprehensiveness of the abridged questionnaires in estimating the societal costs for patients with anxiety or depressive disorders and to assess the impact of productivity costs on the total costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The comprehensiveness of the abridged versions of the TIC-P was assessed in four populations: a group of primary care patients with anxiety disorders (n=175) and three groups of patients with major depressive disorders in various outpatient settings (n=140; n=125; and n=79). Comprehensiveness was measured using the proportion of total health care costs and productivity costs covered by the abridged versions compared to the full-length TIC-P. Costs were calculated according to the guidelines for costing studies using the Dutch costing manual.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Our results showed that the TIC-P Mini covered 26%-64% of health care costs and the TIC-P Midi captured 54%-79% of health care costs. Health care costs in these populations were predominantly dispersed over primary care, outpatient hospital care, outpatient specialist care and inpatient hospital care. The TIC-P Midi and TIC-P Mini captured 22% and 0% of primary care costs respectively. In contrast, inpatient hospital care costs and outpatient specialist mental health care costs were almost fully included in the abridged versions. Costs due to lost productivity as measured by the full-length TIC-P were substantial, representing 38% to 92% of total costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;A reduction of the number of items resulted in a substantial loss in the ability to measure health care costs compared to the full-length TIC-P, because these outpatient populations consumed health care from a variety of health care providers. Two limitations of the study need to be stressed. Firstly, the number of patients in each of the four studies was relatively small. However, results were consistent over the four studies despite the small number of patients. Secondly, we did not take costs of medication into account.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;In developing mental health policy, it is important to include considerations on cost-effectiveness. Increasing the evidence on instruments to measure costs from a societal perspective may support policymakers to adopt a broader perspective.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for further research: &lt;/strong&gt;The TIC-P","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"22 1","pages":"15-24"},"PeriodicalIF":1.6,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37156794","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 Savings from a Navigator Intervention for Repeat Detoxification Clients.","authors":"Dominic Hodgkin,&nbsp;Mary F Brolin,&nbsp;Grant A Ritter,&nbsp;Maria E Torres,&nbsp;Elizabeth L Merrick,&nbsp;Constance M Horgan,&nbsp;Jonna C Hopwood,&nbsp;Natasha De Marco,&nbsp;Andrea Gewirtz","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Many clients with substance use disorders (SUD) have multiple admissions to a 24-hour level of care for detoxification without ever progressing to SUD treatment. In the US, health insurers have become concerned about the high costs and ineffective results of repeat detox admissions. For other diseases, health systems increasingly target high-risk, high-cost patients with individually tailored interventions delivered by `navigators' who help patients negotiate the complex health care system. Patient incentives are another increasingly common intervention.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;(i) To examine how health care spending was affected by an intervention intended to improve entry to SUD treatment among clients who had multiple detox admissions. (ii) To see whether spending effects, overall and by type of service, differed by intervention arm. (iii) To assess whether the intervention resulted in net savings from the payer perspective, after subtracting implementation costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The intervention was implemented in a segment of the Massachusetts Medicaid population, and used Recovery Support Navigators (RSNs) who were trained to effectively engage and connect clients with SUD to follow-up care and community resources. Services were funded using a flat daily rate per client. Additionally, in one of the two intervention arms, clients were offered successive incentive payments for meeting pre-specified milestones to reinforce recovery-oriented behaviors. For this paper, multivariate analyses of claims and administrative data were used to measure the intervention's effect on health care spending, and to estimate net savings to the payer.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Health care spending grew 1.6 percentage points more slowly for intervention-enrolled members than for others, implying gross savings of $68 per member per month. After subtracting intervention-related costs, net savings were estimated at $57 per member per month. The intervention was also associated with shifts in the health care service mix from more to less acute settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;While the results for total spending did not reach statistical significance, they suggest some potential for insurers to reduce the health care costs associated with repeat detox utilization by using a navigator-based intervention. Analyses reported elsewhere found that this intervention had favorable effects on rates of initiation of SUD treatment. Limitations of the study include the fact that neither subjects nor sites were randomized between study groups; lack of data on crime or productivity outcomes; low participant use of RSN services; and a policy change which altered the participant pool and truncated follow-up for some.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;These results suggest some potential for payers to reduce the health care costs associated with repeat detox by us","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"22 1","pages":"3-13"},"PeriodicalIF":1.6,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37156793","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":"PERSPECTIVES: Mental Health Policy in India: Seven Sets of Questions and Some Answers.","authors":"Arshad Mirza,&nbsp;Nirvikar Singh","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;This paper frames the state of mental health policy in India in terms of seven sets of questions, and seeks to provide at least partial answers to these questions, based on a meta-analysis of existing research. The context of the analysis is the arguably poor state of mental health care in India, as well as an unprecedented level of policy attention to the issue.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;In brief, the questions we pose pertain to (i) the provision of such care in hospitals, (ii) non-hospital provision, including by non-medical providers, (iii) issues of education and social acceptance, (iv) affordability, (v) within-country variation of care and possibilities for benchmarking, (vi) aggregate resource impacts of a concerted effort to change policies and improve care, and (vii) the shape of a more effective \"continuum of care\" for mental health issues.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Given the complexity of the subject, this paper is meant to serve as a framing of issues for further research, but in doing so, to clarify what issues are most pressing, those that are most difficult and perhaps those that can be tackled more readily, to create some momentum in changing the relatively poor state of mental health care in India.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;While new laws and policies being introduced in India propose ideas and changes that are groundbreaking for that country, leading to cautious optimism, there still are many gaps in the understanding of the challenges of the provision of increased access to, as well as better quality, mental health care in India. These challenges can be understood on two fronts: one is the psychiatric and medical aspect of the issues, and the other is the management and administration of the system.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Perhaps the highest priority in achieving the goals of greater access and better quality is to increase the number of trained personnel at all levels of specialization and skilling that are relevant. Further, while the new legal framework and policy identify the importance of information technology in rapid expansion of access to mental healthcare, more context-specific research and trials are needed. With respect to the administration and management needs of the public system, important challenges will be the need for significant organizational innovations in the education system, and cultural changes that allow specialized medical professionals to accept the use of software and less-qualified, more dispersed, frontline providers. A final area is the interface between the public and private sectors, including the role of non-profit organizations: challenges include information sharing, division of responsibilities, and resource allocation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;Our analysis suggests that incorporating information technology, along with training professionals at a variety of skill levels in","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"22 1","pages":"25-37"},"PeriodicalIF":1.6,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37156795","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":"Higher Benefit for Greater Need: Understanding Changes in Mental Well-being of Young Adults Following the ACA Dependent Coverage Mandate.","authors":"Dan M Shane,&nbsp;George L Wehby","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Beginning in late 2010, private health insurance plans were required to allow dependents up to age 26 to remain on a parent's plan. Known as the dependent coverage or young adult mandate, this provision increased coverage substantially within the group of 19-25 year-olds affected by the policy change. Subsequent work evaluating whether increased coverage had a positive effect on mental health found mild improvements in self-reported mental health. This work focused exclusively on average effects among young adults in the years after the policy change, leaving open the question of how young adults fared depending on where they reside in terms of the distribution of risk for mental health issues.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;We assess the effects of the dependent coverage mandate on young adult mental well-being focusing on the distribution of mental health issues. We seek to understand how potential improvements (or degradations) differ across the entire risk profile. Gains among individuals who are at low risk for severe mental health issues may send a far different signal than gains among those with higher risks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using MEPS data from 2006 through 2013, we use quantile regression within a difference-in-differences design to compare pre/post outcomes across the distribution of risk for young adults ages 23-25 affected by the mandate to 27-29 year-olds not affected by the mandate. Further, we evaluate differences in the effect of the mandate by sex, given well-known disparities in incidence and prevalence of mental illness between men and women. To gauge the effects of the mandate on mental health, we use the Mental Component Score measure within the MEPS, ideal for our quantile regression given the broad range of scores. The key premise in our evaluation is that individuals with higher risks for mental health problems due to biological or socioeconomics factors are more likely to rank at locations of the mental health score distribution indicating worse outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;We find significant improvements in self-reported mental health in the 23-25 year-old group following the mandate. However, the gains were not equal across the risk distribution. For individuals at the 0.1 quantile (worse self-reported mental health), the improvement in MCS scores was significant, a 6.1% increase compared to the pre-mandate baseline at that quantile. Effects were smaller but still significant at the median but there was no apparent effect for those that were at higher levels of self-reported mental health. Our results also suggest improvements for women (+9% relative to baseline at the 0.1 quantile, e.g.) but limited evidence of an effect for men.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for future research: &lt;/strong&gt;The finding that increased insurance coverage led to improved self-reported mental health foremost for young adults with the highest risk of mental health problems ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 4","pages":"171-180"},"PeriodicalIF":1.6,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398336/pdf/nihms-992764.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36882415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Potential Impact of Alzheimer's Disease Early Treatment on Societal Costs of Care in Czechia: A Simulation Approach.","authors":"Hana M Broulikova,&nbsp;Vaclav Sladek,&nbsp;Marketa Arltova,&nbsp;Jakub Cerny","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In Czechia, only about a quarter of people suffering from the Alzheimer's disease (AD) receive (usually belated) treatment. Because of their more rapid cognitive decline, untreated patients require extensive assistance with basic daily activities earlier than those receiving treatment. This assistance provided at home and nursing homes represents a substantial economic burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;To calculate lifetime costs of care per AD patient and to evaluate potential care savings from early treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We use Monte Carlo simulation to model lifetime societal costs of care per patient under two different scenarios. In the first one, a cohort of 100,000 homogeneous patients receives usual care under which the majority of patients are undiagnosed or diagnosed late. The second scenario models a hypothetical situation in which an identical cohort of patients starts receiving treatment early after the disease onset. Data on the rates of cognitive decline for treated and untreated patients, and survival probability for AD patients are derived from foreign clinical studies. Information on costs and population characteristics is compiled on the basis of published Czech research and databases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Early treatment of AD decreases social lifetime costs of care. This result holds true regardless of gender, age at which the disease is contracted, or whether the patient lives at home or uses a social residential service. The potential savings amount up to Euro 26,800 (23,500) per woman (man), being negatively correlated with the age at which the disease onsets as well as the delay between the onset and treatment initiation DISCUSSION: The results suggest that early treatment of AD would decrease costs of care in Czechia. The main limitation of the simulation arises from the fact that missing domestic information was substituted by input from foreign clinical trials or simplifying assumptions. Because of insufficient data, we do not model hospitalization risk; on the other hand, introduction of this risk into our model would likely increase the savings from early treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;Makers of AD policies ought to appreciate the trade-off between costs of daily assistance in untreated patients and health care costs in treated patients, notwithstanding that the costs of assistance are largely born by households rather than public budgets. Our results show that the savings on costs of assistance brought about by early treatment would exceed the additional costs of treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for further research: &lt;/strong&gt;A number of missing or insufficient data about the Czech Alzheimer's population were identified. In addition, to determine the total societal cost-effect of early treatment, further research ought to evaluate the related increase in detection costs. Finally, it should also a","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 4","pages":"147-161"},"PeriodicalIF":1.6,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36882413","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}