Yonatan-Leus Refael, Strauss Asher Y, Cooper-Kazaz Rena
Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.
Mental Health Services (Talbiya), Clalit Health Services-Jerusalem, Affiliated with The Faculty of Medicine at The Hebrew University Jerusalem, Jerusalem, Israel.
Clin Psychol Psychother. 2021 May;28(3):642-655. doi: 10.1002/cpp.2527. Epub 2020 Nov 12.
Our objective was to examine the effectiveness and efficiency of psychodynamic psychotherapy on the reduction in health care utilization and cost while controlling for age, gender, and year. Health care utilization and cost were examined yearly in 1,675 patients from 2 years before outpatient psychotherapy (i.e., baseline) to three consecutive years after psychotherapy in a naturalistic longitudinal design. A multilevel analytic approach (LMLM) was applied to account for repeated measures effect and missing data. In the year prior to psychotherapy, there was a significant increase in total cost compared with baseline (14.8%) and in use of health care services (primary and specialist doctors' visits and outsourced referrals). In the first year following therapy, there was a significant decrease in total cost (10%) and in use of health care services (all doctors' visits, imaging, and outsourced referrals). The decrease was to baseline levels or lower and was maintained for two additional years. Psychiatric medication usage increased significantly after psychotherapy and remained so. The overall cumulative decrease in total cost per patient over 3 years after therapy was 3,665.92 NIS, equalling a 69% average cost of psychotherapy. Further cost saving can be expected due to the reduction in sick leave, disability, and psychiatric hospitalization. These findings support the notion that providing outpatient psychodynamic psychotherapy can be financially beneficial to health care systems, although further research is required for causal inferences. Also, an increase in health care utilization along with scarce physical findings may indicate unaddressed psychological distress and warrant referral for mental assessment and possible psychotherapy.
我们的目标是在控制年龄、性别和年份的同时，研究心理动力心理治疗在降低医疗保健利用率和成本方面的有效性和效率。采用自然主义纵向设计，对1675名患者从门诊心理治疗前两年（即基线）到心理治疗后连续三年的医疗保健利用率和成本进行逐年评估。应用多水平分析方法（LMLM）来处理重复测量效应和缺失数据。在心理治疗前一年，与基线相比，总成本显著增加（14.8%），医疗保健服务的使用（初级和专科医生就诊以及外部转诊）也显著增加。在治疗后的第一年，总成本显著下降（10%），医疗保健服务的使用（所有医生就诊、影像学检查和外部转诊）也显著下降。下降至基线水平或更低，并持续了另外两年。心理治疗后精神科药物使用显著增加且持续如此。治疗后3年每位患者的总成本累计下降3665.92新谢克尔，相当于心理治疗平均成本的69%。由于病假、残疾和精神科住院治疗的减少，预计还会进一步节省成本。这些发现支持了这样一种观点，即提供门诊心理动力心理治疗对医疗保健系统在经济上可能是有益的，尽管因果推断还需要进一步研究。此外，如果医疗保健利用率增加且身体检查结果不明显，可能表明存在未解决的心理困扰，需要转诊进行心理评估并可能接受心理治疗。
