de Oliveira Claire, Iwajomo Tomisin, Kurdyak Paul
Centre for Health Economics and Hull York Medical School, University of York, York, United Kingdom.
Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Front Health Serv. 2022 Mar 21;2:848072. doi: 10.3389/frhs.2022.848072. eCollection 2022.
Chronic psychotic disorders are severe and disabling mental disorders associated with poor psychiatric and medical outcomes, and among the most costly mental disorders to treat. Understanding trends in aggregate health care expenditures over time, and respective drivers, can provide relevant insights for decision makers, namely around appropriate allocation of scarce resources within the health care sector. Using administrative health care times series data from Ontario, this analysis examined trends in aggregate public health care expenditures and activity from 2012 to 2019 among all individuals with a diagnosis of a chronic psychotic disorder. Total aggregate health care expenditures for individuals with a chronic psychotic disorder in Ontario increased at a moderate rate over this time period, in line with the growth of the number of people diagnosed, and thus not likely driven by unit costs or resource use. Psychiatric hospitalizations made up the largest share of health care expenditures (~30%). Nonetheless, among all health services, expenditures of acute medical hospitalizations, outpatient prescription drugs and home care saw the largest growth over time. Mean/per capita health care expenditures were greater for females, and increased with age as well as with the presence of comorbidities/chronic conditions. In particular, mean/per capita health care expenditures increased steadily with the number of comorbidities and were highest for individuals with 5 or more comorbidities and those with congestive heart failure, highlighting the ever-increasing importance of addressing physical health conditions among this patient population. These findings will have important implications for decision makers, namely around the appropriate allocation of health care resources for patients with chronic psychotic disorders. Future research should continue to monitor health care expenditures for individuals with chronic psychotic disorders as well as extend this analysis beyond 2019 to understand how the COVID-19 pandemic, and resulting lockdowns, has impacted aggregate health care expenditures and outcomes for patients living with chronic psychotic disorders.
慢性精神病性障碍是严重且致残的精神障碍，与不良的精神和医疗结局相关，是治疗成本最高的精神障碍之一。了解总体医疗保健支出随时间的趋势及其各自的驱动因素，可以为决策者提供相关见解，特别是在医疗保健部门内稀缺资源的适当分配方面。利用安大略省的行政医疗保健时间序列数据，本分析研究了2012年至2019年期间所有诊断为慢性精神病性障碍的个体的总体公共医疗保健支出和活动趋势。在此期间，安大略省患有慢性精神病性障碍的个体的总体医疗保健支出以适度的速度增长，与确诊人数的增长一致，因此不太可能由单位成本或资源使用驱动。精神科住院费用占医疗保健支出的最大份额（约30%）。尽管如此，在所有医疗服务中，急性医疗住院、门诊处方药和家庭护理的支出随时间增长最大。女性的平均/人均医疗保健支出更高，并且随着年龄以及合并症/慢性病的存在而增加。特别是，平均/人均医疗保健支出随着合并症的数量稳步增加，对于患有5种或更多合并症的个体以及患有充血性心力衰竭的个体最高，这突出了在这一患者群体中解决身体健康问题的重要性日益增加。这些发现将对决策者产生重要影响，特别是在为慢性精神病性障碍患者适当分配医疗保健资源方面。未来的研究应继续监测慢性精神病性障碍患者的医疗保健支出，并将此分析扩展到2019年以后，以了解2019冠状病毒病大流行及其导致的封锁如何影响慢性精神病性障碍患者的总体医疗保健支出和结局。
