Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Eur J Health Econ. 2020 Jul;21(5):751-761. doi: 10.1007/s10198-020-01170-3. Epub 2020 Mar 17.
Mental disorders are widespread, debilitating and associated with high costs. In Germany, usual care (UC) for mental disorders is afflicted by poor coordination between providers and long waiting times. Recently, the primary alternative to UC-the gatekeeping-based general practitioners (GP) program-was extended by the collaborative Psychiatry-Neurology-Psychotherapy (PNP) program, which is a selective contract designed to improve mental health care and the allocation of resources. Here, we assess the effects of the GP program and the PNP program on costs for mental health care. We analyzed claims data from 2014 to 2016 of 55,472 adults with a disorder addressed by PNP to compare costs and sick leave days between PNP, the GP program and UC. The individuals were grouped and balanced via entropy balancing to adjust for potentially confounding covariates. We employed a negative binomial model to compare sick leave days and two-part models to compare sick pay, outpatient, inpatient and medication costs over a 12-month period. The PNP program significantly reduced sick pay by 164€, compared to UC, and by 177€, compared to the GP program. Consistently, sick leave days were lower in PNP. We found lower inpatient costs in PNP than in UC (-194€) and in the GP program (-177€), but no reduction in those shares of inpatient costs that accrued in psychiatric or neurological departments. Our results suggest that integrating collaborative care elements in a gatekeeping system can favourably impact costs. In contrast, we found no evidence that the widely implemented GP program reduces costs for mental health care.
精神障碍广泛存在，使人衰弱，并导致高昂的成本。在德国，精神障碍的常规护理（UC）存在提供者之间协调不善和候诊时间长的问题。最近，UC 的主要替代方案——基于守门人的全科医生（GP）计划——被合作精神病学-神经病学-心理疗法（PNP）计划扩展，这是一种旨在改善精神卫生保健和资源分配的选择性合同。在这里，我们评估了 GP 计划和 PNP 计划对精神卫生保健成本的影响。我们分析了 2014 年至 2016 年 55472 名接受 PNP 治疗的精神障碍患者的索赔数据，以比较 PNP、GP 计划和 UC 的成本和病假天数。通过熵平衡对个体进行分组和平衡，以调整潜在的混杂协变量。我们采用负二项模型比较病假天数，采用两部分模型比较 12 个月内的病假工资、门诊、住院和药物费用。与 UC 相比，PNP 计划可显著减少 164 欧元的病假工资，与 GP 计划相比，可减少 177 欧元的病假工资。相应地，PNP 计划的病假天数较低。我们发现 PNP 的住院费用低于 UC（-194 欧元）和 GP 计划（-177 欧元），但在精神病学或神经病学部门发生的住院费用份额没有减少。我们的研究结果表明，在守门系统中整合协作护理元素可以有利地影响成本。相比之下，我们没有发现广泛实施的 GP 计划可以降低精神卫生保健成本的证据。
