PharmacoEconomics & Outcomes News 784, p20 - 12 Aug 2017 Higher cost sharing in mental health leads to greater costs Higher cost sharing for mental healthcare can lead to a reduction in treatment and greater costs for involuntary commitment and acute care in some patient groups, according to findings of a Dutch study published in JAMA Psychiatry. The Netherlands government increased out-of-pocket (OOP) costs for mental health services in adult patients by €100 €200 per year for outpatient treatment and €150 per month for inpatient treatment from 1 January 2012. This study used data from all administrative mental health treatment records from organisations in the Dutch association for mental health service providers to investigate changes in mental healthcare use and costs in adults after versus before increased cost sharing (2012 vs 2010 2011), compared with changes in adolescents aged 15 17 years who had no increase in OOP costs (controls). In total, 1 448 541 treatment records for mental health patients were opened between 2010 and 2012. After increased cost sharing was introduced in adults, the number of mental healthcare records opened per day decreased by 13.4% (p<0.001), with greater reductions in patients with severe disorders and in low- income neighbourhoods, while record openings per day increased by 96.8% for involuntary commitment and by 25.1% for acute mental healthcare (both p<0.001 vs before OOP cost increase). During the same period, use of regular mental healthcare increased slightly and use of involuntary commitment and acute care decreased slightly in adolescents. Higher cost sharing in adults was estimated to save €13.4 million overall. However, additional costs of involuntary commitment and acute care exceeded savings by €19.5 million in patients with psychotic disorders and by €6.0 million in patients with bipolar disorders. "Higher cost sharing for seriously ill and low-income patients could discourage treatment of vulnerable populations and create substantial downstream costs," concluded the authors. "These findings suggest that this new mental health care cost-sharing policy failed to achieve its goal of achieving cost savings by selectively reducing low-value mental health care . . . Citing the decrease in the number of patients seeking outpatient treatment and the increase in involuntary commitments, the Dutch Health Authority rolled back and eventually removed these mental health co-payments during 2013 and 2014," said Dr Benjamin Druss from Emory University, Altlanta, Georgia, USA, in an accompanying invited commentary "Without careful planning published in JAMA Psychiatry. and oversight, mental health care cost-sharing programs may exact a steep price," he said. 1. Ravesteijn B, et al. Association of Cost Sharing With Mental Health Care Use, Involuntary Commitment, and Acute Care. JAMA Psychiatry : 19 Jul 2017. Available from: URL: http://doi.org/10.1001/jamapsychiatry.2017.1847. 2. Druss BG. Cost Sharing and Mental Health Care: A Cautionary Tale From the Netherlands. JAMA Psychiatry : 19 Jul 2017. Available from: URL: http:// doi.org/10.1001/jamapsychiatry.2017.1837. 1173-5503/17/0784-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved PharmacoEconomics & Outcomes News 12 Aug 2017 No. 784
PharmacoEconomics & Outcomes News – Springer Journals
Published: Aug 12, 2017
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