Journal of Mental Health Policy and Economics最新文献

{"title":"Estimating Impact Based on Stages of Mental Illness on Employment and Earnings in Bangkok Metropolitan Region.","authors":"Tawanchai Jirapramukpitak, Keerati Pattanaseri, Kia-Chong Chua, Patcharapim Takizawa","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests mental disorders are associated with substantial economic burden. However, as the status of mental illness tends to change over time, estimating the burden based on cross-sectional presence or severity of illness may be problematic. An approach based on illness staging may provide a more stable estimate.</p><p><strong>Aims of the study: </strong>We aim to explore whether three predefined stages of mental illness (i.e. early active, remitted, chronic) have differential impact on employment and earnings.</p><p><strong>Methods: </strong>A community survey of household population aged 18 and over in a university hospital's catchment area within Bangkok Metropolitan Region (BMR) was conducted (N=3877). The third version of the World Health Organization-Composite International Diagnostic Interview (WHO-CIDI) was administered to assess lifetime and 12-month common major mental disorders and the Kessler Psychological Distress Scale (K6) to assess current psychological distress. Multivariate approaches were used to estimate the observed and expected annual earnings and employment for persons with mental illness at each stage, controlling for sociodemographic variables.</p><p><strong>Results: </strong>Increasing level of chronicity, from the early active to the remitted and then to the chronic stage, was associated with increasing reduction in earnings (beta --0.14 95% CI -0.15 to --0.13, p = 0.004). All stages of illness were significantly associated with reduced earnings, with individuals at chronic stage having 12-month earnings averaging 78,522 Thai baht (USD 2,356) less than those without a history of mental illness, followed by those at remitted (38,703 baht or USD 1,161) and early active stages (25,870 baht or USD 776), with the same values for control variables. Remitted and chronic stages, but not early active one, were associated with reduced odds of paid employment. The estimated societal-level loss in earnings was 26.9 billion baht (USD 808.2 million) in the total BMR population.</p><p><strong>Discussion: </strong>The findings suggest that all stages of mental disorders, particularly chronic one, are associated with substantial individual- and societal-level burden, and highlight differences in employment and earnings gaps among individuals at each stage of illness.</p><p><strong>Implications for health care provision and use: </strong>Mental health service should be provided in close coordination with vocational and welfare services in order to alleviate financial and work difficulties faced by mentally ill people at various stages of illness.</p><p><strong>Implications for health policies: </strong>There is a need to tailor disability benefits and employment promotion schemes to the needs of mentally ill people at each stage in order to maximize their productivity and quality of life.</p><p><strong>Implications for further research: </strong>Direct and other indirect costs of mental illness sh","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 4","pages":"163-170"},"PeriodicalIF":1.6,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36882414","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":"Effects of the Mental Health Parity and Addiction Equity Act on Specialty Outpatient Behavioral Health Spending and Utilization.","authors":"Alex K Gertner, Jason Rotter, Gracelyn Cruden","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>For decades, insurance plans in the United States have applied more restrictive treatment limits and higher cost-sharing burdens for mental health and substance use treatments compared to physical health treatments. The Mental Health Parity and Addiction Equity Act (MHPAEA) required health plans that offer mental health and substance use benefits to offer them at parity with physical health benefits starting in January 2010.</p><p><strong>Aims of the study: </strong>To determine the effect of MHPAEA on out-of-pocket spending and utilization of outpatient specialty behavioral health services.</p><p><strong>Methods: </strong>The proportion of individuals with at least one outpatient specialty behavioral health visit, the average number of visits among those with any behavioral health visit, and the proportion of behavioral health spending paid out-of-pocket were obtained from the nationally-representative Medical Expenditure Panel Survey (MEPS) for the years 2006 to 2013. Difference-in-differences models were estimated comparing individuals with employer-sponsored insurance to those with Medicaid, Medicare, or who were uninsured.</p><p><strong>Results: </strong>Out-of-pocket share of spending was lowest among Medicaid (2.0%) and highest among the uninsured (22%), followed by the employer group (13%). Individuals in Medicaid had the highest proportion of any behavioral health visit (11%) and the uninsured had the lowest (2.4%). Among those with any behavioral health visits, the average number of visits was similar across groups. Our primary and sensitivity analyses suggest MHPAEA did not lead to changes in utilization or spending on specialty outpatient behavioral visits for individuals with employer-sponsored insurance compared to other groups.</p><p><strong>Discussion: </strong>Potential reasons for MHPAEA's apparent lack of effect are that health plans were already at parity before the law's passage, that many health plans continue to be out of compliance with the law, that concurrent changes in plans' cost-sharing blunted the law's effects, and that other barriers to behavioral health service use continue to limit utilization. While our study cannot provide direct evidence of these mechanisms, we review existing evidence in support of each of them. Our study had several limitations. We cannot test definitively whether the difference-in-differences assumption was violated or fully control for time-varying differences between groups. We attempt to address this by using multiple control groups and presenting evidence of parallel trends before MHPAEA implementation. Second, because our data do not have state identifiers, we cannot control for which states had existing mental health parity laws. Third, a nationally representative analysis may mask substantial heterogeneity for affected subgroups.</p><p><strong>Implications for health policies: </strong>We find no evidence MHPAEA substantially affected behavioral health","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 3","pages":"91-103"},"PeriodicalIF":1.6,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36764550","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":"Attention Deficit Hyperactivity Disorder (ADHD) and its Comorbid Mental Disorders: An Evaluation of their Labor Market Outcomes.","authors":"Joseph Hartge, Patricia Toledo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Attention-deficit/hyper-activity disorder's (ADHD) prevalence rate has been increasing during the last decade. Evidence from different studies suggests that the effect of ADHD on earnings and employment could be more detrimental than other disorders such as depression or anxiety. Although it is widely known that these mental disorders can coexist with ADHD, none of these studies has considered the joint evaluation of ADHD and its comorbidities.</p><p><strong>Objective: </strong>In this paper, we evaluate whether ADHD is a more severe disorder than three other comorbid mental disorders -- learning disabilities, depression, and anxiety -- regarding their effects on earnings and employment.</p><p><strong>Methods: </strong>We use the National Longitudinal Study of Adolescent to Adult Health to estimate regression models of earnings and employment. We consider the use of the sampling weights, school fixed effects, and multiple imputation of missing values. Robustness checks include a more exogenous measure of depression.</p><p><strong>Results: </strong>On average, an individual with ADHD or depression (but not both) has around 20% lower earnings than those without any of these disorders. The earnings gap for learning disabilities is around 25%. The probability of being employed is 5 percentage points lower for an individual who has any of these disorders. Anxiety is not associated with lower earnings. Females with learning disabilities have an earnings gap that is 20 percentage points larger than males. The employment gap for females or African Americans with learning disabilities is 8%.</p><p><strong>Discussion and limitations: </strong>In contrast to existing evidence, we find that ADHD is not more serious than learning disabilities or depression. Although the magnitude of each employment gap is not substantial, the fact that these are comorbid disorders indicates that their joint occurrence could be detrimental for employment. Females and African Americans with learning disabilities could face more adverse labor market outcomes. Even though our results are robust to a more exogenous measure of depression, the potential endogeneity of the diagnosis of ADHD or anxiety could still bias the estimates. However, baseline results are also robust when individuals with an age of diagnosis equal to the year of the interview are dropped from the estimations.</p><p><strong>Implications for health policy and for future research: </strong>The increasing number of Supplemental Security Income beneficiaries with ADHD is in line with the observed tendency to screen for ADHD more frequently than for other comorbid disorders, and with the evidence of ADHD overdiagnosis. Since our study shows that other disorders are equally or potentially more disabling than ADHD in terms of labor market outcomes, mental health policies should be reoriented to prevent policies targeting ADHD from crowding out those for other mental disorders. It would ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 3","pages":"105-121"},"PeriodicalIF":1.6,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36764552","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 Adaption of the Client Sociodemographic and Service Receipt Inventory for Costing Mental Health Services in Brazil.","authors":"Aglae Sousa, Andrea A Cardoso, Monia Kayo, Guilherme Gregorio, Jair de Jesus Mari, Denise Razzouk","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>There is a scarcity of tested instruments for measuring mental health services and costs. The Client Sociodemographic Service Receipt Inventory (CSSRI) is the most used tool in economic evaluation in mental health in Europe; it was translated into five languages, and it was mainly used to evaluate deinstitutionalisation process in mental health system reform.</p><p><strong>Aims of the study: </strong>To translate and adapt to the Brazilian healthcare system, and to test its inter-rater reliability, validity and its feasibility in a deinstitutionalized sample of psychiatric hospital living in residential facilities.</p><p><strong>Method: </strong>The translation and adaptation of CSSRI to Brazilian context was done by a focus group with eight experts on public mental health services, covering all the available Brazilian healthcare services. Decisions on the extent of conceptual overlap between British and Brazilian version were discussed until reaching expert consensus. The inter-rater reliability and applicability of this version, called ``Inventário Sociodemográfico de Uso e Custos de Serviços - ISDUCS'', was tested in a sample of 30 subjects with moderate to severe mental disorders living in residential facilities. Because the lack of medical record or another source, ISDUCS's validity was assessed using Kappa coefficient agreement to compare between resident`s answers and their professional carers`answers.</p><p><strong>Results: </strong>The same structure of the original instrument was kept, with an additional list of items for costing consumable services. The main modifications were on items related to education, occupational status and on detailed descriptions of public health services. The agreement between two mental health raters was good to excellent for the majority of items, with Kappa coefficient ranged from 0.6 to 1.0. Because 43% of the sample was unable to answer questions about regularly taken medications and consultations with health professionals, an exploratory analysis was done to identify potentially related variables. Greater severity of psychiatric symptoms and lower independent living skills were related to the inability to answer these questions. Agreement between residents and carers was good to excellent for socio and demographic variables, living situation and occupational status, income, visits to a psychologist, occupational therapists and social workers.</p><p><strong>Conclusion: </strong>ISDUCS is the first tool for economic evaluation including mental health services translated and adapted to Brazilian context. Despite the widespread use of CRSSI among people with schizophrenia in Europe, this study found that greater severity of symptoms led to high rate of missing responses. Inter-rater reliability was excellent as a whole. Small sample size didn't allow generalisation of results of this preliminary testing.</p><p><strong>Implications for health provision and use: </strong>ISDUCS","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 3","pages":"131-142"},"PeriodicalIF":1.6,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36764555","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":"An Economic Evaluation of Coordinated Specialty Care (CSC) Services for First-Episode Psychosis in the U.S. Public Sector.","authors":"Sean M Murphy,&nbsp;Suat Kucukgoncu,&nbsp;Yuhua Bao,&nbsp;Fangyong Li,&nbsp;Cenk Tek,&nbsp;Nicholas J K Breitborde,&nbsp;Sinan Guloksuz,&nbsp;Vivek H Phutane,&nbsp;Banu Ozkan,&nbsp;Jessica M Pollard,&nbsp;John D Cahill,&nbsp;Scott W Woods,&nbsp;Robert A Cole,&nbsp;Michael Schoenbaum,&nbsp;Vinod H Srihari","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Schizophrenia spectrum disorders exert a large and disproportionate economic impact. Early intervention services may be able to alleviate the burden of schizophrenia spectrum disorders on diagnosed individuals, caregivers, and society at large. Economic analyses of observational studies have supported investments in specialized team-based care for early psychosis; however, questions remain regarding the economic viability of first-episode services in the fragmented U.S. healthcare system. The clinic for Specialized Treatment Early in Psychosis (STEP) was established in 2006, to explicitly model a nationally-relevant U.S. public-sector early intervention service. The purpose of this study was to conduct an economic evaluation of STEP, a Coordinated Specialty Care service (CSC) based in a U.S. State-funded community mental health center, relative to usual treatment (UT).</p><p><strong>Methods: </strong>Eligible patients were within 5 years of psychosis onset and had no more than 12 weeks of lifetime antipsychotic exposure. Participants were randomized to STEP or UT. The annual per-patient cost of the STEP intervention per se was estimated assuming a steady-state caseload of 30 patients. A cost-offset analysis was conducted to estimate the net value of STEP from a third-party payer perspective. Participant healthcare service utilization was evaluated at 6 months and over the entire 12 months post randomization. Generalized linear model multivariable regressions were used to estimate the effect of STEP on healthcare costs over time, and generate predicted mean costs, which were combined with the per-patient cost of STEP.</p><p><strong>Results: </strong>The annual per-patient cost of STEP was $1,984. STEP participants were significantly less likely to have any inpatient or ED visits; among individuals who did use such services in a given period, the associated costs were significantly lower for STEP participants at month 12. We did not observe a similar effect with regard to other healthcare services. The predicted average total costs were lower for STEP than UT, indicating a net benefit for STEP of $1,029 at month 6 and $2,991 at month 12; however, the differences were not statistically significant.</p><p><strong>Conclusions: </strong>Our findings are promising with regard to the value of STEP to third-party payers.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 3","pages":"123-130"},"PeriodicalIF":1.6,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314808/pdf/nihms-1003367.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36764553","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":"A Cost-effectiveness Study of the Impact of the Affordable Care Act on Depression Outcomes in the United States.","authors":"Babak Mohit","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>Two separate changes in insurance regulation have altered mental health delivery to Americans: (i) the Mental Health Parity and Addiction Equity Act (MHPA 2008) and (ii) the Patient Protection and Affordable Care Act (ACA 2010). This study aims to model and provide estimates for the costs and effects of depression that are impacted by these regulations.</p><p><strong>Method: </strong>Literature exists on the effectiveness of insurance coverage in reducing the prevalence, the costs of treatment and lost productivity time, as well as the health related quality of life (HRQL) associated with depression. Data from this literature is employed in a Markov model to obtain costs and effects associated with depression under both the MHPA and the ACA regulations as compared to without either one.</p><p><strong>Results: </strong>The implementation of these regulations may reduce the per capita lifetime costs of depression treatment and lost productivity by USD 215 and enhance life expectancy by 0.01 Quality Adjusted Life Years (QALY) per capita.</p><p><strong>Conclusions: </strong>If the savings of these regulations are expanded over the entire cohort of Americans adults, the potential cost savings from treated depression are estimated at USD 47.30 billion in addition to 2.2 million QALYs saved.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 2","pages":"71-78"},"PeriodicalIF":1.6,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36273284","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":"Child Labor Hazard on Mental Health: Evidence from Brazil.","authors":"Temidayo James Aransiola,&nbsp;Marcelo Justus","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Child labor has been usually claimed to produce negative effects on health. However, most of the studies that investigated this hypothesis examined only its impact on child laborers' physical health. This study formulates the hypothesis that child labor may have an impact on the mental health of these individuals.</p><p><strong>Aims of study: </strong>The aim of this study was to investigate the risk of child laborers to develop symptoms of depression in adulthood and to examine the role of physical and mental health of the family members on their risk of developing depression.</p><p><strong>Data and methods: </strong>We used the 2008 National Household Sample Survey (PNAD, Pesquisa Nacional por Amostra de Domicilios) and its special supplements to estimate probit models.</p><p><strong>Results: </strong>Individuals who started working between the age group of 15-17 have about 0.6 percentage points lesser risk of developing depression as compared to those who started working between the age group of 10-14. Further reduction of this risk was observed for the age groups of 18-19 and 20-24. No statistical evidence was found regarding older age groups. Individuals with a mother with depression have about 3.2 percentage points higher risk of presenting symptoms of depression. Chronic physical illness in mothers increases the risk of depression in child laborers by 0.3 percentage points.</p><p><strong>Discussion and conclusion: </strong>Our study supports the hypothesis that work during childhood increases the risk of developing depression in adulthood. Family mental health status and chronic physical illness play a substantial role in the risk that child laborers have to develop depression.</p><p><strong>Implications for health policies: </strong>The results of the study indicate the need of basic mental health services aimed to the assessment and care for child laborers who withdraw from work, with the aim of reducing the risk of depression in adulthood. The results underline also the importance of mental health assessment and care for those children with a family member with depression or chronic physical illness.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 2","pages":"49-58"},"PeriodicalIF":1.6,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36273282","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-effectiveness Analysis of a Stepped, Collaborative and Coordinated Health Care Network for Patients with Somatoform Disorders (Sofu-Net).","authors":"Thomas Grochtdreis,&nbsp;Christian Brettschneider,&nbsp;Meike Shedden-Mora,&nbsp;Katharina Piontek,&nbsp;Hans-Helmut König,&nbsp;Bernd Löwe","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Somatoform disorders are highly prevalent mental disorders causing impairment and large economic burden. In order to improve the diagnosis and management of affected patients, a health care network for somatoform disorders (Sofu-Net) was implemented in primary care.</p><p><strong>Aims of the study: </strong>The aim of the study was to determine the cost-effectiveness of a stepped, collaborative and coordinated health care network for somatoform and functional disorders (Sofu-Net) compared with regular primary care physician (PCP) practices in German primary care from a societal perspective.</p><p><strong>Methods: </strong>This study was part of a 6-month controlled, prospective, non-randomized, observer-blinded cluster cohort trial. Participants were recruited from 33 PCP practices in Hamburg, Germany. The health care network was a collaboration of PCPs, psychotherapists, inpatient clinics and a specialized outpatient clinic. Participants in the control group received usual care. A cost-effectiveness analysis, using treatment response as measure of effectiveness, was performed. Uncertainty in cost-effectiveness was analyzed using cost-effectiveness acceptability curves.</p><p><strong>Results: </strong>In total, n=218 patients (n=119 patients in the intervention group and n=99 patients in the control group) were included in the study. At 6 months, patients within the Sofu-Net group did not differ significantly from the control group with regard to costs (533; standard error 941) and treatment response (--10.3%). For Sofu-Net, the probability of being cost-effective at a willingness-to-pay (WTP) of 10,000 per additional response to treatment was only 31%.</p><p><strong>Discussion: </strong>Sofu-Net is unlikely to be cost-effective. Even for high WTP, the probability of cost-effectiveness was low. The results were robust to variation of costs included in the analysis as well as when only complete cases were included in the analysis. The most important limitations of the study were that randomization could not be established at patient level and at practice level and that the study design did not allow measurement of costs at baseline.</p><p><strong>Conclusion: </strong>Patients with severe somatic symptoms did not benefit from the health care network. Sofu-Net might have reduced costs in patients with moderate somatic symptoms.</p><p><strong>Implications for further research: </strong>Owing to the limitations and due to a short follow-up of this study, further cost-effectiveness analyses with high methodological quality and a follow-up of at least one year are needed in order to produce results that are more reliable.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 2","pages":"59-69"},"PeriodicalIF":1.6,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36273283","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":"Measuring Efficiency at the Interface of Behavioral and Physical Health Care.","authors":"Parashar Pravin Ramanuj, Deborah M Scharf, Erin Ferenchick, Brigitta Spaeth-Rublee, Harold Alan Pincus","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Measures of efficiency in healthcare delivery, particularly between different parts of the healthcare system could potentially improve health resource utilization. We use a typology adapted from the Agency for Healthcare Research and Quality to characterize current measures described in the literature by stakeholder perspective (payer, provider, patient, policy-maker), type of output (reduced utilization or improved outcomes) and input (physical, financial or both).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;To systematically describe measures of healthcare efficiency at the interface of behavioral and physical healthcare and identify gaps in the literature base that could form the basis for further measure development.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched the Medline database for studies published in English in the last ten years with the terms 'efficiency', 'inefficiency', 'productivity', 'cost' or 'QALY' and 'mental' or 'behavioral' in the title or abstract. Studies on healthcare resource utilization, costs of care, or broader healthcare benefits to society, related to the provision of behavioral health care in physical health care settings or to people with physical health conditions or vice versa were included.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;85 of 6,454 studies met inclusion criteria. These 85 studies described 126 measures of efficiency. 100 of these measured efficiency according to the perspective of the purchaser or provider, whilst 13 each considered efficiency from the perspective of society or the consumer. Most measures counted physical resources (such as numbers of therapy sessions) rather than the costs of these resources as inputs. Three times as many measures (95) considered service outputs as did quality outcomes (31).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Measuring efficiency at the interface of behavioral and physical care is particularly difficult due to the number of relevant stakeholders involved, ambiguity over the definition of efficiency and the complexity of providing care for people with multimorbidity. Current measures at this interface concentrate on a limited range of outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;We only searched one database and did not review the gray literature, nor solicit a call for relevant but unpublished work. We did not assess the methodological quality of the studies identified.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implication for health care provision and use: &lt;/strong&gt;Most measures of healthcare efficiency are currently viewed from the perspective of payers and providers, with very few studies addressing the benefits of healthcare to society or the individual interest of the consumer. One way this imbalance could be addressed is through much stronger involvement of consumers in measurement-development, for example, by an expansion in patient-reported outcome measures in assessing quality of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;Integrating behavioral ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 2","pages":"79-86"},"PeriodicalIF":1.0,"publicationDate":"2018-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36273285","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":"Changes in the Utilization of Mental Health Care Services and Mental Health at the Onset of Medicare.","authors":"Jordan H Rhodes","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The onset of Medicare eligibility at age 65 in the U.S. is accompanied by significant changes in health insurance coverage rates. This presents a unique opportunity to study the interaction among health insurance, health care utilization, and health outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;This study examines if changes in mental health outcomes accompany the changes in health insurance coverage rates at age 65.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;2006-2013 data from the Sample Adult and Person File components of the National Health Insurance Survey are used to explore the link between the onset of Medicare and the utilization of mental health care services and mental health. A regression discontinuity design is employed to test for changes in perceived financial barriers to mental health care, visits with mental health professionals, and self-reported mental health. In addition to identifying the overall effect, analysis is also conducted on samples that are stratified by level of education to test for heterogeneous treatment effects across socioeconomic groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The coverage changes that occur at age 65 are associated with a substantial decline in self-reported financial barriers to receiving mental health care. This effect is greatest among individuals from lower socioeconomic backgrounds. Despite the decline in the percentage of adults claiming they did not obtain mental health care services because of prohibitive costs, no significant changes in mental health visits or self-reported mental health are identified. The implementation of lower cost-sharing requirements for outpatient mental health care through the Medicare Patients and Providers Act of 2008 (MIPPA) has had no statistically significant effect on mental health visits at the age 65 cutoff for Medicare eligibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;There is no estimated change in mental health visits, yet prohibitive costs of mental health care decline, especially among individuals from lower socioeconomic groups. These findings may be the result of newly eligible Medicare enrollees either increasing their utilization of mental health visits on the intensive margin, obtaining alternative sources of treatment for mental illness, or facing other barriers to care that are unrelated to costs. Additionally, estimates pertaining to mental health visits are imprecise, and large changes relative to age 64 means cannot be ruled out.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;There is no evidence that gaining health insurance coverage at age 65 results in increased visits with mental health professionals on the extensive margin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policy: &lt;/strong&gt;For the previously uninsured and under-insured, the onset of Medicare coverage at age 65 results in a reduction in cost-sharing requirements for mental health care. These reductions have no clear effect on overall mental health v","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 1","pages":"29-41"},"PeriodicalIF":1.6,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35998592","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}