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
€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
"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
published in JAMA Psychiatry.
"Without careful planning
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://
PharmacoEconomics & Outcomes News 12 Aug 2017 No. 7841173-5503/17/0784-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved