Journal of Mental Health Policy and Economics最新文献

{"title":"Increased Mental Health Treatment Financing, Community-Based Organization's Treatment Programs, and Latino-White Children's Financing Disparities.","authors":"Lonnie R Snowden, Neal Wallace, Kate Cordell, Genevieve Graaf","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aims: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p><p><strong>Implications for policy: </strong>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.</p><p><strong>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}

{"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, Werner B F Brouwer, Leona Hakkaart","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aims of the study: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>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.</p><p><strong>Implications for health care provision and use: </strong>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.</p><p><strong>Implications for health policies: </strong>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}

{"title":"Cost-effectiveness Analysis of an Aftercare Service vs Treatment-As-Usual for Patients with Severe Mental Disorders.","authors":"Eshagh Barfar, Vandad Sharifi, Homayoun Amini, Yasaman Mottaghipour, Masud Yunesian, Mehdi Tehranidoost, Payam Sobhebidari, 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}

{"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}

{"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}

{"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}

{"title":"Costs and Performance of English Mental Health Providers.","authors":"Valerie Moran,&nbsp;Rowena Jacobs","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion and limitations: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;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}

{"title":"Reduction in Costs after Treating Comorbid Panic Disorder with Agoraphobia and Generalized Anxiety Disorder.","authors":"Vedrana Ikic,&nbsp;Claude Belanger,&nbsp;Stephane Bouchard,&nbsp;Patrick Gosselin,&nbsp;Frederic Langlois,&nbsp;Joane Labrecque,&nbsp;Michel J Dugas,&nbsp;Andre Marchand","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are impairing and costly disorders that are often misdiagnosed and left untreated despite multiple consultations. These disorders frequently co-occur, but little is known about the costs associated with their comorbidity and the impact of cognitive-behavioral therapy (CBT) on cost reduction.</p><p><strong>Aims of the study: </strong>The first objective of this study was to assess the mental health-related costs associated with the specific concomitance of PDA and GAD. The second aim was to determine whether there is a reduction in direct and indirect mental health-related costs following conventional CBT for the primary disorder only (PDA or GAD) or combined CBT adapted to the comorbidity (PDA and GAD).</p><p><strong>Methods: </strong>A total of 123 participants with a double diagnosis of PDA and GAD participated in this study. Direct and indirect mental health-related costs were assessed and calculated from a societal perspective at the pre-test, the post-test, and the three-month, six-month and one-year follow-ups.</p><p><strong>Results: </strong>At the pre-test, PDA-GAD comorbidity was found to generate a mean total cost of CADUSD 2,000.48 (SD = USD 2,069.62) per participant over a three-month period. The indirect costs were much higher than the direct costs. Both treatment modalities led to significant and similar decreases in all cost categories from the pre-test to the post-test. This reduction was maintained until the one-year follow-up.</p><p><strong>Discussion: </strong>Methodological choices may have underestimated cost evaluations. Nonetheless, this study supports the cost offset effects of both conventional CBT for primary PDA or GAD and combined CBT for PDA-GAD comorbidity.</p><p><strong>Implications for healthcare provision and use: </strong>Treatment of comorbid and costly disorders with evidence-based treatments such as CBT may lead to considerable economic benefits for society.</p><p><strong>Implications for health policies: </strong>Considering the limited resources of healthcare systems, it is important to make choices that will lead to better accessibility of quality services. The application of CBT for PDA, GAD or both disorders and training mental health professionals in this therapeutic approach should be encouraged. Additionally, it would be favorable for insurance plans to reimburse employees for expenses associated with psychological treatment for anxiety disorders.</p><p><strong>Implications for further research: </strong>In addition to symptom reduction, it would be of great pertinence to explore which factors can contribute to reducing direct and indirect mental health-related costs.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 1","pages":"11-20"},"PeriodicalIF":1.6,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34921774","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":"Willingness to Pay in Caregivers of Patients Affected by Schizophrenia.","authors":"Claudiane Salles Daltio,&nbsp;Cecilia Attux,&nbsp;Marcos Bosi Ferraz","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Schizophrenia is a debilitating disorder that often requires the affected individual to receive care from a caregiver. Willingness to Pay (WTP) technique allows a valuation of the health state preferences by assessing the impact of the disease and translating it into monetary terms.</p><p><strong>Aims of the study: </strong>The objective was to determine the WTP of schizophrenic patients' caregivers on a hypothetical recovery scenario and correlate it to socio-demographic and clinical characteristics, Knowledge of Disease, Quality of life and Burden of Disease.</p><p><strong>Methods: </strong>A convenience sample consecutively assessed 189 outpatients' caregivers from Schizophrenia Program of Federal University of Sao Paulo. A single caregiver was considered for each patient, taking into consideration their close relationship and their direct involvement in the treatment. Open WTP questionnaire for a hypothetical schizophrenia recovery scenario, KAST (Knowledge of Disease), SF-6D (Quality of life) and ZBI-22 (Burden of Disease) scales were applied.</p><p><strong>Results: </strong>A monthly WTP mean value (SD) of USUSD 63.63 (111.88) was found. The average value (SD) found was 12.96 (2.45) on KAST, 0.78 (0.08) on SF6D and 29.91 (16.10) on ZARIT. Income, education, social class, knowledge of disease and burden of caregiver were positively correlated to the WTP value. By linear regression model, income and education remained significant.</p><p><strong>Conclusion: </strong>Willingness to Pay (WTP) is a method that can be used to determine the strength of preference of patients and caregivers for a recovery in schizophrenia. The higher the income and education, the higher the willingness to pay. No clinical characteristics of patients had a statistically significant relation to the value the caregiver would pay.</p><p><strong>Implications for health policies: </strong>WTP is a potentially useful tool to determine values and health care preferences, and can be used for the development of mental health policies.</p><p><strong>Implications for further research: </strong>Future research should be used to enhance WTP tool in mental health studies on the impact of diseases, including schizophrenia.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 1","pages":"3-10"},"PeriodicalIF":1.6,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34920794","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: Accountability for Mental Health: The Australian Experience.","authors":"Sebastian Rosenberg,&nbsp;Luis Salvador-Carulla","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Australia was one of the first countries to develop a national policy for mental health. A persistent characteristic of all these policies has been their reference to the importance of accountability. What does this mean exactly and have we achieved it? Can Australia tell if anybody is getting better?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;To review accountability for mental health in Australia and question whether two decades of Australian rhetoric around accountability for mental health has been fulfilled.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This paper first considers the concept of accountability and its application to mental health. We then draw on existing literature, reports, and empirical data from national and state governments to illustrate historical and current approaches to accountability for mental health. We provide a content analysis of the most current set of national indicators. The paper also briefly considers some relevant international processes to compare Australia's progress in establishing accountability for mental health.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Australia's federated system of government permits competing approaches to accountability, with multiple and overlapping data sets. A clear national approach to accountability for mental health has failed to emerge. Existing data focuses on administrative and health service indicators, failing to reflect broader social factors which reveal quality of life. In spite of twenty years of investment and effort Australia has been described as outcome blind, unable to demonstrate the merit of USD 8bn spent on mental health annually.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion and limitations: &lt;/strong&gt;While it may be prolific, existing administrative data provide little outcomes information against which Australia can genuinely assess the health and welfare of people with a mental illness. International efforts are evolving slowly.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health care provision and use: &lt;/strong&gt;Even in high income countries such as Australia, resources for mental health services are constrained. Countries cannot afford to continue to invest in services or programs that fail to demonstrate good outcomes for people with a mental illness or are not value for money.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for health policies: &lt;/strong&gt;New approaches are needed which ensure that chosen accountability indicators reflect national health and social priorities. Such priorities must be meaningful to a range of stakeholders and the community about the state of mental health. They must drive an agenda of continuous improvement relevant to those most affected by mental disorders. These approaches should be operable in emerging international contexts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Implications for further research: &lt;/strong&gt;Australia must further develop its approach to health accountability in relation to mental health. A limited set of new preferred national mental health indicators should be agreed. T","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"20 1","pages":"37-54"},"PeriodicalIF":1.6,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34921777","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}