Journal of Mental Health Policy and Economics最新文献

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Cost-effectiveness and Budget Impact of Specialized Psychotherapy for Borderline Personality Disorder: A Synthesis of the Evidence. 边缘型人格障碍专业心理治疗的成本-效果和预算影响:综合证据。
IF 1.6 4区 医学
Pim Wetzelaer, Joran Lokkerbo, Arnoud Arntz, Thea van Aselt, Filip Smit, Silvia Evers
{"title":"Cost-effectiveness and Budget Impact of Specialized Psychotherapy for Borderline Personality Disorder: A Synthesis of the Evidence.","authors":"Pim Wetzelaer, Joran Lokkerbo, Arnoud Arntz, Thea van Aselt, Filip Smit, Silvia Evers","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Specialized outpatient psychotherapy for patients with borderline personality disorder (BPD) is expected to reduce their use of other health care resources. It is currently unknown to what extent the costs of providing these interventions can be expected to be offset by a reduction in other health care costs in the Netherlands. To establish the cost-effectiveness and budget impact of specialized outpatient psychotherapy, the estimated incremental costs are synthesized with the estimated incremental effects. We have developed a method for the synthesis of all relevant evidence on clinical effectiveness as well as health care resource use.</p><p><strong>Aim of the study: </strong>The aim of this article is to present a method for the synthesis of evidence for cost-effectiveness and budget impact analysis with a specific application to specialized outpatient psychotherapy for borderline personality disorder in the Netherlands.</p><p><strong>Methods: </strong>A systematic search of the English-language literature is performed to retrieve evidence on the clinical effectiveness and the health care resource use following 12 months of specialized outpatient psychotherapy for borderline personality disorder. The available evidence is used as an input for a model-based economic evaluation. Simulated patient-level data are used to provide overall estimates of the incremental costs and incremental effects, which serve to assess the cost-effectiveness and budget impact of specialized outpatient psychotherapy for borderline personality disorder in the Netherlands.</p><p><strong>Results: </strong>The results indicate that specialized outpatient psychotherapy for BPD can be considered cost-effective and that its scaling up to Dutch national level would require an investment of 2.367 million (95% C.I.: 1,717,000 - 3,272,000) per 1,000 additional patients with BPD. Sensitivity analyses demonstrated the robustness of our findings in light of several uncertain components and assumptions in our calculations, but also their sensitivity to the choice of included studies based on the comparator condition and the assumption of high intervention costs.</p><p><strong>Discussion: </strong>We present a method for the synthesis of evidence from different types of studies in a way that respects the uncertainty surrounding those findings. Limitations of the study pertain to the inclusion of findings from studies with suboptimal designs, the transferability of research findings, and uncertainty regarding the time horizon considered. More research is needed on the sensitivity of our findings to the choice of included studies based on the comparator condition.</p><p><strong>Implications for health care provision and use: </strong>THE results suggest that the provision of specialized outpatient psychotherapy for BPD leads to a reduction in other health care resource use. Overall, the results are promising and encourage future studies on aspects that ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 4","pages":"177-190"},"PeriodicalIF":1.6,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35708478","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}
引用次数: 0
Do High Fidelity Wraparound Services for Youth with Serious Emotional Disturbances Save Money in the Long-Term? 为有严重情绪困扰的青少年提供高保真的全方位服务,长远来看能省钱吗?
IF 1.6 4区 医学
Angela Snyder, James Marton, Susan McLaren, Bo Feng, Mei Zhou
{"title":"Do High Fidelity Wraparound Services for Youth with Serious Emotional Disturbances Save Money in the Long-Term?","authors":"Angela Snyder,&nbsp;James Marton,&nbsp;Susan McLaren,&nbsp;Bo Feng,&nbsp;Mei Zhou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Treating youth with serious emotional disturbances (SED) is expensive often requiring institutional care. A significant amount of recent federal and state funding has been dedicated to expanding home and community-based services for these youth as an alternative to institutional care. High Fidelity Wraparound (Wrap) is an evolving, evidence-informed practice to help sustain community-based placements for youth with an SED through the use of intensive, customized care coordination among parents, multiple child-serving agencies, and providers. While there is growing evidence on the benefits of Wrap, few studies have examined health care spending associated with Wrap participation and none have examined spending patterns after the completion of Wrap. Merging health care spending data from multiple agencies and programs allows for a more complete picture of the health care costs of treating these youth in a system-of-care framework.</p><p><strong>Aims of study: </strong>(i) To compare overall health care spending for youth who transitioned from institutional care into Wrap (the treatment group) versus youth not receiving Wrap (the control group) and (ii) to compare changes in health care spending, overall and by category, for both groups before (the pre-period) and after (the post-period) Wrap participation.</p><p><strong>Methods: </strong>The treatment group (N=161) is matched to the control group (N=324) temporally based on the month the youth entered institutional care. Both total health care spending and spending by category are compared for each group pre- and post-Wrap participation. The post-period includes the time in which the youth was receiving Wrap services and one year afterwards to capture long-term cost impacts.</p><p><strong>Results: </strong>In the year before Wrap participation, the treatment group averaged USD 8,433 in monthly health care spending versus USD 4,599 for the control group. Wrap participation led to an additional reduction of USD 1,130 in monthly health care spending as compared to the control group in the post-period. For youth participating in Wrap, these spending reductions were the result of decreases in mental health inpatient spending and general outpatient spending.</p><p><strong>Discussion: </strong>Youth participating in Wrap had much higher average monthly costs than youth in the control group for the year prior to entering Wrap, suggesting that the intervention targeted youth with the highest mental health utilization and likely more complex needs. While both groups experienced reductions in spending, the treatment group experienced larger absolute reductions, but smaller relative reductions associated with participation. These differences were driven mainly by reductions in mental health inpatient spending. Larger reductions in general outpatient spending for the treatment group suggest spillover benefits in terms of physical health care spending. Further analysis is needed t","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 4","pages":"167-175"},"PeriodicalIF":1.6,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35708477","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}
引用次数: 0
The Affordable Care Act's Dependent Care Coverage Expansion and Behavioral Health Care. 《平价医疗法案》的家属医疗保险覆盖面扩大和行为医疗。
IF 1.6 4区 医学
Chandler B McClellan
{"title":"The Affordable Care Act's Dependent Care Coverage Expansion and Behavioral Health Care.","authors":"Chandler B McClellan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In September 2010, the Affordable Care Act (ACA) extended dependent care coverage to individuals under the age of 26, allowing young adults to remain on their parent's private insurance.</p><p><strong>Aims of the study: </strong>This policy offers a natural experiment to examine the impact of expanded insurance coverage on mental health and substance use treatment utilization and payment composition.</p><p><strong>Methods: </strong>Using National Survey on Drug Use and Health (NSDUH) and Medical Expenditure Panel Survey (MEPS) data between 2005 and 2014, this study employs a difference-in-differences approach with 23-25 year olds as the treatment group and 27-30 year olds as the control group to examine the impact of the expansion on insurance coverage, behavioral health treatment utilization, and treatment payment source.</p><p><strong>Results: </strong>Results indicate that the dependent care coverage expansion is associated with an increase in insurance coverage, greater mental health treatment utilization, and an increase in payment for behavioral health treatment by private insurance.</p><p><strong>Discussion: </strong>This study shows that insurance coverage increased and financial barriers to getting behavioral health treatment fell. Improving access to care only led to increases in mental health treatment utilization, while substance use treatment utilization remained unchanged.</p><p><strong>Implications: </strong>The ACA succeeded in extending insurance benefits to a population that has been historically underinsured. Along with those benefits, young adults enjoyed greater access to behavioral health care and a measure of financial protection from high costs. While the evidence has yet to be presented for the full implementation of the ACA, if these results are typical of its other provisions, then the ACA will have achieved some of its most important objectives.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 3","pages":"111-130"},"PeriodicalIF":1.6,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35469993","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}
引用次数: 0
Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities. 增加心理健康治疗资金,社区组织的治疗项目,拉丁裔和白人儿童的资金差距。
IF 1.6 4区 医学
Lonnie R Snowden, Neal Wallace, Kate Cordell, Genevieve Graaf
{"title":"Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities.","authors":"Lonnie R Snowden,&nbsp;Neal Wallace,&nbsp;Kate Cordell,&nbsp;Genevieve Graaf","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Latino child populations are large and growing, and they present considerable unmet need for mental health treatment. Poverty, lack of health insurance, limited English proficiency, stigma, undocumented status, and inhospitable programming are among many factors that contribute to Latino-White mental health treatment disparities. Lower treatment expenditures serve as an important marker of Latino children's low rates of mental health treatment and limited participation once enrolled in services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims: &lt;/strong&gt;We investigated whether total Latino-White expenditure disparities declined when autonomous, county-level mental health plans receive funds free of customary cost-sharing charges, especially when they capitalized on cultural and language-sensitive mental health treatment programs as vehicles to receive and spend treatment funds. Using Whites as benchmark, we considered expenditure pattern disparities favoring Whites over Latinos and, in a smaller number of counties, Latinos over Whites.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using segmented regression for interrupted time series on county level treatment systems observed over 64 quarters, we analyzed Medi-Cal paid claims for per-user total expenditures for mental health services delivered to children and youth (under 18 years of age) during a study period covering July 1, 1991 through June 30, 2007. Settlement-mandated Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) expenditure increases began in the third quarter of 1995. Terms were introduced to assess immediate and long term inequality reduction as well as the role of culture and language-sensitive community-based programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Settlement-mandated increased EPSDT treatment funding was associated with more spending on Whites relative to Latinos unless plans arranged for cultural and language-sensitive mental health treatment programs. However, having programs served more to prevent expenditure disparities from growing than to reduce disparities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;EPSDT expanded funding increased proportional expenditures for Whites absent cultural and language-sensitive treatment programs. The programs moderate, but do not overcome, entrenched expenditure disparities. These findings use investment in mental health services for Latino populations to indicate treatment access and utilization, but do not explicitly reflect penetration rates or intensity of services for consumers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for policy: &lt;/strong&gt;New funding, along with an expectation that Latino children's well documented mental health treatment disparities will be addressed, holds potential for improved mental health access and reducing utilization inequities for this population, especially when specialized, culturally and linguistically sensitive mental health treatment programs are present to serve as recipients of funding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 3","pages":"137-145"},"PeriodicalIF":1.6,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35469995","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}
引用次数: 0
Clinicians' Views on Therapeutic Outcomes of Systemic Interventions and on the Ability of the EQ-5D to Capture these Outcomes. 临床医生对系统干预治疗结果的看法以及EQ-5D捕捉这些结果的能力。
IF 1.6 4区 医学
Saskia J Schawo, Werner B F Brouwer, Leona Hakkaart
{"title":"Clinicians' Views on Therapeutic Outcomes of Systemic Interventions and on the Ability of the EQ-5D to Capture these Outcomes.","authors":"Saskia J Schawo,&nbsp;Werner B F Brouwer,&nbsp;Leona Hakkaart","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Systemic interventions focus on improvements of interactions between clients and their environments, and are increasingly used to treat adolescents with problems of substance use and delinquency. Clients' progress may include broad and non-medical effects. When performing economic evaluations of these interventions, the common outcome of costs per quality adjusted life year (cost/QALY) may not capture all of these effects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;The current study is an explorative study. It aims to investigate which outcomes clinicians consider relevant to the therapeutic success of systemic interventions and whether these, according to them, are sufficiently captured by the EQ-5D instrument.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Semi-structured interviews were performed with seven clinicians at two mental health institutions in the Netherlands. Clinicians were asked to list the most relevant outcomes of systemic interventions. They were asked whether they considered the EQ-5D dimensions to sufficiently capture these outcomes or if they missed aspects or outcome domains.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The clinicians mentioned several broad effects relevant for the evaluation of systemic interventions. These were aspects of family functioning, parental functioning, social competencies, school attendance, etc. They considered several EQ-5D dimensions relevant (i.e. in particular 'usual activities' and 'anxiety/depression'), yet they indicated that the instrument lacked systemic dimensions (i.e. family relations and relations with others) and addiction-related aspects.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The interviewed clinicians considered several dimensions of the EQ-5D useful in evaluating effects of systemic interventions, yet they expressed the need to add additional dimensions particularly relevant to systemic aspects to the instrument when performing economic evaluations of systemic interventions. The explorative analysis was limited by the small number of interviewed clinicians. Furthermore, a relatively high proportion of clinicians were specialized in Multidimensional Family Therapy, a type of systemic intervention particularly used to treat adolescents with substance use disorders and related problems. Hence the importance of addiction-related improvements may have been over-emphasized in this group of respondents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;Practical implications of the current study may be the need for enhancements of the current health economic methodology for evaluating systemic interventions as to capture additional aspects specifically relevant to these interventions. This may lead to different choices in the use of instruments for the evaluation of treatment progress and success in clinical practice.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;By improving the health economic toolkit to evaluate systemic interventions one may prov","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 3","pages":"131-136"},"PeriodicalIF":1.6,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35469994","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}
引用次数: 0
Cost-effectiveness Analysis of an Aftercare Service vs Treatment-As-Usual for Patients with Severe Mental Disorders. 重度精神障碍患者康复服务与常规治疗的成本-效果分析。
IF 1.6 4区 医学
Eshagh Barfar, Vandad Sharifi, Homayoun Amini, Yasaman Mottaghipour, Masud Yunesian, Mehdi Tehranidoost, Payam Sobhebidari, Arash Rashidian
{"title":"Cost-effectiveness Analysis of an Aftercare Service vs Treatment-As-Usual for Patients with Severe Mental Disorders.","authors":"Eshagh Barfar,&nbsp;Vandad Sharifi,&nbsp;Homayoun Amini,&nbsp;Yasaman Mottaghipour,&nbsp;Masud Yunesian,&nbsp;Mehdi Tehranidoost,&nbsp;Payam Sobhebidari,&nbsp;Arash Rashidian","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>There have been claims that community mental health principles leads to the maintenance of better health and functioning in patients and can be more economical for patients with severe and chronic mental disorders. Economic evaluation studies have been used to assess the cost-effectiveness of national health programs, or to propose efficient strategies for health care delivery.</p><p><strong>Aims of the study: </strong>The current study is intended to test the cost-effectiveness of an Aftercare Service when compared with Treatment-As-Usual for patients with severe mental disorders in Iran.</p><p><strong>Methods: </strong>This study was a parallel group randomized controlled trial. A total of 160 post-discharge eligible patients were randomized into two equal patient groups, Aftercare Service (that includes either Home Visiting Care, or Telephone Follow-up for outpatient treatment) vs Treatment-As-Usual, using stratified balanced block randomization method. All patients were followed for 12 months after discharge. The perspective of the present study was the societal perspective. The outcome measures were the rate of readmission at the hospitals after discharge, psychotic symptoms, manic symptoms, depressive symptoms, illness severity, global functioning, quality of life, and patients' satisfaction with the services. The costs included the intervention costs and the patient and family costs in the evaluation period.</p><p><strong>Results: </strong>There was no significant difference in effectiveness measures between the two groups. The Aftercare Service arm was about 66,000 US$ cheaper than Treatment-As-Usual arm. The average total cost per patient in the Treatment-As-Usual group was about 4651 USD, while it was reduced to 3823 US$ in the Aftercare Service group; equivalent to a cost reduction of about 800 USD per patient per year.</p><p><strong>Discussion and limitations: </strong>Given that there was no significant difference in effectiveness measures between the two groups (slightly in favor of the intervention), the Aftercare Service was cost-effective. The most important limitation of the study was the relatively small sample size due to limited budget for the implementation of the study. A larger sample size and longer follow-ups are warranted.</p><p><strong>Implications for health care provision, use and policies: </strong>Considering the limited resources and equity concerns for health systems, the importance of making decisions about healthcare interventions based on cost-effectiveness evidence is increasing. Our results suggest that the aftercare service can be recommended as an efficient service delivery mode, especially when psychiatric bed requirements are insufficient for a population.</p><p><strong>Implications for further research: </strong>Further research should continue the work done with a larger sample size and longer follow-ups to further establish the cost-effectiveness analysis of an aftercar","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 3","pages":"101-110"},"PeriodicalIF":1.6,"publicationDate":"2017-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35469992","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}
引用次数: 0
Does Eating Out Make Elderly People Depressed? Empirical Evidence from National Health and Nutrition Survey in Taiwan. 下馆子吃饭会让老年人抑郁吗?台湾“国民健康与营养调查”之实证证据。
IF 1.6 4区 医学
Hung-Hao Chang, Kannika Saeliw
{"title":"Does Eating Out Make Elderly People Depressed? Empirical Evidence from National Health and Nutrition Survey in Taiwan.","authors":"Hung-Hao Chang,&nbsp;Kannika Saeliw","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>OBJECTIVES: This study investigates the association between eating out and depressive symptoms among elderly people. Potential mediators that may link to elderly eating out and depressive symptoms are also discussed.\u0000METHODS: A unique dataset of 1,184 individuals aged 65 and older was drawn from the National Health and Nutrition Survey in 2008 in Taiwan. A bivariate probit model and an instrumental variable probit model were estimated to account for correlated, unmeasured factors that may be associated with both the decision and frequency of eating out and depressive symptoms in the elderly. An additional analysis is conducted to check whether the nutrient intakes and body weights can be seen as mediators that link the association between eating out and depressive symptoms of the elderly.\u0000RESULTS: Elderly people who eat out are 38 percent points more likely to have depressive symptoms than their counterparts who do not eat out, after controlling for socio-demographic characteristics and other factors. A positive association between the frequency of eating out and the likelihood of having depressive symptoms of the elderly is also found. It is evident that one additional meal away from home is associated with an increase of the likelihood of being depressed by 3.8 percentage points. With respect to the mediations, we find that nutrient intakes and body weight are likely to serve as mediators for the positive relationship between eating out and depressive symptoms in the elderly.\u0000CONCLUSION: Our results show that elderly who eat out have a higher chance of having depressive symptoms. To prevent depressive symptoms in the elderly, policy makers should be aware of the relationship among psychological status, physical health and nutritional health when assisting the elderly to better manage their food consumption away from home.\u0000LIMITATONS AND IMPLICATIONS FOR FUTURE RESEARCH: Our study have some caveats. First, the interpretation of our results on the causality issue calls for caution in that our analysis relies on a cross-sectional survey. Second, other measures to define elderly depression, such as the Center for Epidemiological Studies -Depression (CES-D) score, can be used to check the robustness of our findings. Finally, the availability of food outlets in the local area and family characteristics are possible associated with food away from home of the elderly. If data permit, the relationship between eating out and elderly depressive symptoms can be better identified after controlling for variables related to food facilities and family characteristics.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 2","pages":"63-73"},"PeriodicalIF":1.6,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35917158","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}
引用次数: 0
Mental Health Insurance Parity and Provider Wages. 精神健康保险平价和提供者工资。
IF 1.6 4区 医学
Ezra Golberstein, Susan H Busch
{"title":"Mental Health Insurance Parity and Provider Wages.","authors":"Ezra Golberstein,&nbsp;Susan H Busch","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Policymakers frequently mandate that employers or insurers provide insurance benefits deemed to be critical to individuals' well-being. However, in the presence of private market imperfections, mandates that increase demand for a service can lead to price increases for that service, without necessarily affecting the quantity being supplied. We test this idea empirically by looking at mental health parity mandates.</p><p><strong>Objective: </strong>This study evaluated whether implementation of parity laws was associated with changes in mental health provider wages.</p><p><strong>Method: </strong>Quasi-experimental analysis of average wages by state and year for six mental health care-related occupations were considered: Clinical, Counseling, and School Psychologists; Substance Abuse and Behavioral Disorder Counselors; Marriage and Family Therapists; Mental Health Counselors; Mental Health and Substance Abuse Social Workers; and Psychiatrists. Data from 1999-2013 were used to estimate the association between the implementation of state mental health parity laws and the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act and average mental health provider wages.</p><p><strong>Results: </strong>Mental health parity laws were associated with a significant increase in mental health care provider wages controlling for changes in mental health provider wages in states not exposed to parity (3.5 percent [95% CI: 0.3%, 6.6%]; p<.05).</p><p><strong>Discussion: </strong>Mental health parity laws were associated with statistically significant but modest increases in mental health provider wages.</p><p><strong>Implications: </strong>Health insurance benefit expansions may lead to increased prices for health services when the private market that supplies the service is imperfect or constrained. In the context of mental health parity, this work suggests that part of the value of expanding insurance benefits for mental health coverage was captured by providers. Given historically low wage levels of mental health providers, this increase may be a first step in bringing mental health provider wages in line with parallel health professions, potentially reducing turnover rates and improving treatment quality.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 2","pages":"75-82"},"PeriodicalIF":1.6,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35080348","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}
引用次数: 0
Does Eating Out Make Elderly People Depressed? Empirical Evidence from National Health and Nutrition Survey in Taiwan. 下馆子吃饭会让老年人抑郁吗?台湾“国民健康与营养调查”之实证证据。
IF 1.6 4区 医学
Hung-Hao Chang, Kannika Saeliw
{"title":"Does Eating Out Make Elderly People Depressed? Empirical Evidence from National Health and Nutrition Survey in Taiwan.","authors":"Hung-Hao Chang,&nbsp;Kannika Saeliw","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates the association between eating out and depressive symptoms among elderly people. Potential mediators that may link to elderly eating out and depressive symptoms are also discussed.</p><p><strong>Methods: </strong>A unique dataset of 1,184 individuals aged 65 and older was drawn from the National Health and Nutrition Survey in 2008 in Taiwan. A bivariate probit model and an instrumental variable probit model were estimated to account for correlated, unmeasured factors that may be associated with both the decision and frequency of eating out and depressive symptoms in the elderly. An additional analysis is conducted to check whether the nutrient intakes and body weights can been seen as mediators that link the association between eating out and depressive symptoms of the elderly.</p><p><strong>Results: </strong>Elderly people who eat out are 38 percent points more likely to have depressive symptoms than their counterparts who do not eat out, after controlling for socio-demographic characteristics and other factors. A positive association between the frequency of eating out and the likelihood of having depressive symptoms of the elderly is also found. It is evident that one addition meal away from home is associated with an increase of the likelihood of being depressed by 3.8 percentage points. With respect to the mediations, we find that nutrient intakes and body weight are likely to serve as mediators for the positive relationship between eating out and depressive symptoms in the elderly.</p><p><strong>Conclusion: </strong>Our results show that elderly who eat out have a higher chance of having depressive symptoms. To prevent depressive symptoms in the elderly, policy makers should be aware of the relationship among psychological status, physical health and nutritional health when assisting the elderly to better manage their food consumption away from home.</p><p><strong>Limitations and implications for future research: </strong>Our study have some caveats. First, the interpretation of our results on the causality issue calls for caution in that our analysis relies on a cross-sectional survey. Second, other measures to define elderly depression, such as the Center for Epidemiological Studies-Depression (CES-D) score, can be used to check the robustness of our findings. Finally, the availability of food outlets in the local area and family characteristics are possibly associated with food away from home of the elderly. If data permit, the relationship between eating out and elderly depressive symptoms can be better identified after controlling for variables related to food facilities and family characteristics.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 1","pages":"63-74"},"PeriodicalIF":1.6,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35080347","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}
引用次数: 0
Costs and Performance of English Mental Health Providers. 英国心理健康提供者的成本和绩效。
IF 1.6 4区 医学
Valerie Moran, Rowena Jacobs
{"title":"Costs and Performance of English Mental Health Providers.","authors":"Valerie Moran,&nbsp;Rowena Jacobs","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Despite limited resources in mental health care, there is little research exploring variations in cost performance across mental health care providers. In England, a prospective payment system for mental health care based on patient needs has been introduced with the potential to incentivise providers to control costs. The units of payment under the new system are 21 care clusters. Patients are allocated to a cluster by clinicians, and each cluster has a maximum review period.</p><p><strong>Aims of the study: </strong>The aim of this research is to explain variations in cluster costs between mental health providers using observable patient demographic, need, social and treatment variables. We also investigate if provider-level variables explain differences in costs. The residual variation in cluster costs is compared across providers to provide insights into which providers may gain or lose under the new financial regime.</p><p><strong>Methods: </strong>The main data source is the Mental Health Minimum Data Set (MHMDS) for England for the years 2011/12 and 2012/13. Our unit of observation is the period of time spent in a care cluster and costs associated with the cluster review period are calculated from NHS Reference Cost data. Costs are modelled using multi-level log-linear and generalised linear models. The residual variation in costs at the provider level is quantified using Empirical Bayes estimates and comparative standard errors used to rank and compare providers.</p><p><strong>Results: </strong>There are wide variations in costs across providers. We find that variables associated with higher costs include older age, black ethnicity, admission under the Mental Health Act, and higher need as reflected in the care clusters. Provider type, size, occupancy and the proportion of formal admissions at the provider-level are also found to be significantly associated with costs. After controlling for patient- and provider-level variables, significant residual variation in costs remains at the provider level.</p><p><strong>Discussion and limitations: </strong>The results suggest that some providers may have to increase efficiency in order to remain financially viable if providers are paid national fixed prices (tariffs) under the new payment system. Although the classification system for payment is not based on diagnosis, a limitation of the study is the inability to explore the effect of diagnosis due to poor coding in the MHMDS.</p><p><strong>Implications for health care provision and use: </strong>We find that some mental health care providers in England are associated with higher costs of provision after controlling for characteristics of service users and providers. These higher costs may be associated with higher quality care or with inefficient provision of care.</p><p><strong>Implications for health policies: </strong>The introduction of a national tariff is likely to provide a strong incentive to reduce costs","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 2","pages":"83-94"},"PeriodicalIF":1.6,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35080349","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}
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