Department of Psychiatry II, Ulm University, Ulm, Germany.
Int J Health Policy Manag. 2015 Jan 27;4(3):153-60. doi: 10.15171/ijhpm.2015.16. eCollection 2015 Mar.
There is limited evidence on the course of health service costs before and after psychiatric inpatient treatment, which might also be affected by source of cost data. Thus, this study examines: i) differences in health care costs before and after psychiatric inpatient treatment, ii) whether these differences vary by source of cost-data (self-report vs. administrative), and iii) predictors of cost differences over time.
Sixty-one psychiatric inpatients gave informed consent to their statutory health insurance company to provide insurance records and completed assessments at admission and 6-month follow-up. These were compared to the self-reported treatment costs derived from the "Client Socio-demographic and Service Use Inventory" (CSSRI-EU) for two 6-month observation periods before and after admission to inpatient treatment to a large psychiatric hospital in rural Bavaria. Costs were divided into subtypes including costs for inpatient and outpatient treatment as well as for medication.
Sixty-one participants completed both assessments. Over one year, the average patient-reported total monthly treatment costs increased from € 276.91 to € 517.88 (paired Wilcoxon Z = -2.27; P = 0.023). Also all subtypes of treatment costs increased according to both data sources. Predictors of changes in costs were duration of the index admission and marital status.
Self-reported costs of people with severe mental illness adequately reflect actual service use as recorded in administrative data. The increase in health service use after inpatient treatment can be seen as positive, while the pre-inpatient level of care is a potential problem, raising the question whether more or better outpatient care might have prevented hospital admission. Findings may serve as a basis for future studies aiming at furthering the understanding of what to expect regarding appropriate levels of post-hospital care, and what factors may help or inhibit post-discharge treatment engagement. Future research is also needed to examine long-term effects of inpatient psychiatric treatment on outcome and costs.
关于精神科住院治疗前后的医疗服务成本的发展轨迹，目前的证据有限，而且这些成本可能还会受到成本数据来源的影响。因此，本研究旨在：i）检验精神科住院治疗前后的医疗保健成本差异；ii）检验这些差异是否因成本数据来源（自我报告 vs. 行政）的不同而有所不同；iii）检验预测成本随时间变化的因素。
61 名精神科住院患者在知情同意的情况下，允许其法定健康保险公司提供保险记录，并在入院时和 6 个月随访时完成评估。在巴伐利亚农村地区的一家大型精神病院住院治疗前后，将这两次评估与从“客户社会人口统计学和服务使用清单”（CSSRI-EU）中得出的、为期两个 6 个月的观察期内的自我报告治疗费用进行了比较。费用分为多个亚型，包括住院和门诊治疗以及药物治疗费用。
61 名参与者完成了两次评估。在一年的时间里，根据患者自我报告，每月治疗总费用从 276.91 欧元增加到 517.88 欧元（配对 Wilcoxon Z = -2.27；P = 0.023）。根据两种数据来源，所有治疗费用的亚型都有所增加。成本变化的预测因素是指数住院时间和婚姻状况。
患有严重精神疾病的患者自我报告的费用充分反映了行政数据中记录的实际服务使用情况。住院治疗后医疗服务使用的增加可以视为积极的现象，而住院前的护理水平可能是一个潜在的问题，这引发了一个问题，即是否可以提供更多或更好的门诊护理，以防止住院。研究结果可以作为未来研究的基础，旨在进一步了解预期的适当的住院后护理水平，以及哪些因素可能有助于或阻碍出院后的治疗参与。还需要进一步研究，以检验精神科住院治疗对结果和成本的长期影响。
