{"title":"Addiction:entries and exits. Edited by Jon Elster. New York: Sage, 1999","authors":"R. Pacula","doi":"10.1002/MHP.92","DOIUrl":"https://doi.org/10.1002/MHP.92","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 1","pages":"165-166"},"PeriodicalIF":1.6,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78740860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-19DOI: 10.1002/1099-176X(200003)3:1<11::AID-MHP66>3.0.CO;2-0
William S. Cartwright
<div> <section> <h3> Background:</h3> <p>How valuable is public investment in treatment for drug abuse and dependency in the real world of everyday practice? Does drug abuse treatment provide benefits and how are they valued? What are the costs of obtaining outcomes and benefits? Cost–benefit analysis attempts to answer these questions in a standard analytic framework.</p> </section> <section> <h3> Aims:</h3> <p>This paper reviews cost–benefit analyses with scientific merit so that analysts will have a current picture of the state of the research. It will also give public decision-makers information with regards to the available evidence for policy purposes.</p> </section> <section> <h3> Method:</h3> <p>Bibliographic searches were performed. Studies were obtained through the assistance of the Parklawn Health Library system, a component of the US Public Health Service. Selected studies were from the scientific literature with the exception of eight studies published as governmental reports.</p> </section> <section> <h3> Results:</h3> <p>Cost–benefit studies have fallen into the following categories: (i) planning models for delivery systems in states and cities; (ii) short-term follow-up studies of individuals, (iii) single individual programs and (iv) state system's monitoring of outcomes. In 18 cost–benefit studies, a persistent finding is that benefits exceed costs, even when not all benefits are accounted for in the analysis. Much variation is found in the implementation of cost–benefit methods, and this is detailed across discussions of effectiveness, benefits and costs. Studies have emphasized the cost savings to society from the reduction in external costs created by the behavioral consequences of addiction and drug use.</p> </section> <section> <h3> Discussion:</h3> <p>Economic analysis of drug treatment requires sophisticated conceptualization and measurement. Cost–benefit analysis of drug treatment has been a significant analytical exercise since the early 1970s when the public drug treatment system was founded in the United States.</p> </section> <section> <h3> Conclusion:</h3> <p>Drug abuse treatment services may be considered as contributing positive economic returns to society. However, considerable work needs to be done to standardize methods used in the studies. A striking area of omission is the absence of studies for adolescents and only one for women in treatment.</p> </section> <section> <
{"title":"Cost–benefit analysis of drug treatment services: review of the literature†","authors":"William S. Cartwright","doi":"10.1002/1099-176X(200003)3:1<11::AID-MHP66>3.0.CO;2-0","DOIUrl":"https://doi.org/10.1002/1099-176X(200003)3:1<11::AID-MHP66>3.0.CO;2-0","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background:</h3>\u0000 \u0000 <p>How valuable is public investment in treatment for drug abuse and dependency in the real world of everyday practice? Does drug abuse treatment provide benefits and how are they valued? What are the costs of obtaining outcomes and benefits? Cost–benefit analysis attempts to answer these questions in a standard analytic framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims:</h3>\u0000 \u0000 <p>This paper reviews cost–benefit analyses with scientific merit so that analysts will have a current picture of the state of the research. It will also give public decision-makers information with regards to the available evidence for policy purposes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method:</h3>\u0000 \u0000 <p>Bibliographic searches were performed. Studies were obtained through the assistance of the Parklawn Health Library system, a component of the US Public Health Service. Selected studies were from the scientific literature with the exception of eight studies published as governmental reports.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>Cost–benefit studies have fallen into the following categories: (i) planning models for delivery systems in states and cities; (ii) short-term follow-up studies of individuals, (iii) single individual programs and (iv) state system's monitoring of outcomes. In 18 cost–benefit studies, a persistent finding is that benefits exceed costs, even when not all benefits are accounted for in the analysis. Much variation is found in the implementation of cost–benefit methods, and this is detailed across discussions of effectiveness, benefits and costs. Studies have emphasized the cost savings to society from the reduction in external costs created by the behavioral consequences of addiction and drug use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion:</h3>\u0000 \u0000 <p>Economic analysis of drug treatment requires sophisticated conceptualization and measurement. Cost–benefit analysis of drug treatment has been a significant analytical exercise since the early 1970s when the public drug treatment system was founded in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion:</h3>\u0000 \u0000 <p>Drug abuse treatment services may be considered as contributing positive economic returns to society. However, considerable work needs to be done to standardize methods used in the studies. A striking area of omission is the absence of studies for adolescents and only one for women in treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 1","pages":"11-26"},"PeriodicalIF":1.6,"publicationDate":"2000-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200003)3:1<11::AID-MHP66>3.0.CO;2-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72157708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: Depression is one of the most ancient and common diseases of the human race and its burden on society is really impressive. This stems both from the epidemiological spread (lifetime prevalence rate, up to 30 years of age, was estimated as greater than 14.4% by Angst et al.) and from the economic burden on healthcare systems and society, but also as it pertains to patient well-being. AIMS OF THE STUDY: The scope of this review was to examine studies published in the international literature to describe and compare the social costs of depression in various countries. METHODS: A bibliographic search was performed on international medical literature databases (Medline, Embase), where all studies published after 1970 were selected. Studies were carefully evaluated and only those that provided cost data were included in the comparative analysis; this latter phase was conducted using a newly developed evaluation chart. RESULTS: 10 abstracts were firstly selected; 46 of them underwent a subsequent full paper reading, thus providing seven papers, which were the subject of the in-depth comparative analysis: three studies investigated the cost of depression in the USA, three studies in the UK and one study was related to Italy. All the studies examined highlight the relevant economic burden of depression; in 1990, including both direct and indirect costs, it accounted for US$ 43.7 billion in the US (US$ 65 billion, at 1998 prices) according to Greenberg and colleagues, whilst direct costs accounted for £417 million in the UK (or US$ 962.5 million, at 1998 prices), according to Kind and Sorensen. Within direct costs, the major cost driver was indeed hospitalization, which represented something in between 43 and 75% of the average per patient cost; conversely, drug cost accounted for only 2% to 11% in five out of seven studies. DISCUSSION: Indeed, our review suggests that at the direct cost level, in both the United States and the United Kingdom, the burden of depression is remarkable, and this is confirmed by a recent report issued by the Pharmaceutical Research and Manufacturers Association (PhRMA) where prevalence and cost of disease were compared for several major chronic diseases, including Alzheimer, asthma, cancer, depression, osteoporosis, hypertension, schizophrenia and others: in this comparison, depression is one of the most significant diseases, ranked third by prevalence and sixth in terms of economic burden. Moreover, in terms of the average cost per patient, depression imposes a societal burden that is larger than other chronic conditions such as hypertension, rheumatoid arthritis, asthma and osteoporosis. The application of economic methods to the epidemiological and clinical field is a relatively recent development, as evidenced by the finding that, out of the seven studies examined, three refer to the US environment, three to the UK and one to Italy, while nothing was available about the cost of depression for large countries suc
{"title":"Depression: cost-of-illness studies in the international literature, a review","authors":"Patrizia Berto, Daniele D'Ilario, Pierfrancesco Ruffo, Roberto Di Virgilio, Fortunato Rizzo","doi":"10.1002/1099-176X(200003)3:1<3::AID-MHP68>3.0.CO;2-H","DOIUrl":"https://doi.org/10.1002/1099-176X(200003)3:1<3::AID-MHP68>3.0.CO;2-H","url":null,"abstract":"BACKGROUND: Depression is one of the most ancient and common diseases of the human race and its burden on society is really impressive. This stems both from the epidemiological spread (lifetime prevalence rate, up to 30 years of age, was estimated as greater than 14.4% by Angst et al.) and from the economic burden on healthcare systems and society, but also as it pertains to patient well-being. AIMS OF THE STUDY: The scope of this review was to examine studies published in the international literature to describe and compare the social costs of depression in various countries. METHODS: A bibliographic search was performed on international medical literature databases (Medline, Embase), where all studies published after 1970 were selected. Studies were carefully evaluated and only those that provided cost data were included in the comparative analysis; this latter phase was conducted using a newly developed evaluation chart. RESULTS: 10 abstracts were firstly selected; 46 of them underwent a subsequent full paper reading, thus providing seven papers, which were the subject of the in-depth comparative analysis: three studies investigated the cost of depression in the USA, three studies in the UK and one study was related to Italy. All the studies examined highlight the relevant economic burden of depression; in 1990, including both direct and indirect costs, it accounted for US$ 43.7 billion in the US (US$ 65 billion, at 1998 prices) according to Greenberg and colleagues, whilst direct costs accounted for £417 million in the UK (or US$ 962.5 million, at 1998 prices), according to Kind and Sorensen. Within direct costs, the major cost driver was indeed hospitalization, which represented something in between 43 and 75% of the average per patient cost; conversely, drug cost accounted for only 2% to 11% in five out of seven studies. DISCUSSION: Indeed, our review suggests that at the direct cost level, in both the United States and the United Kingdom, the burden of depression is remarkable, and this is confirmed by a recent report issued by the Pharmaceutical Research and Manufacturers Association (PhRMA) where prevalence and cost of disease were compared for several major chronic diseases, including Alzheimer, asthma, cancer, depression, osteoporosis, hypertension, schizophrenia and others: in this comparison, depression is one of the most significant diseases, ranked third by prevalence and sixth in terms of economic burden. Moreover, in terms of the average cost per patient, depression imposes a societal burden that is larger than other chronic conditions such as hypertension, rheumatoid arthritis, asthma and osteoporosis. The application of economic methods to the epidemiological and clinical field is a relatively recent development, as evidenced by the finding that, out of the seven studies examined, three refer to the US environment, three to the UK and one to Italy, while nothing was available about the cost of depression for large countries suc","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 1","pages":"3-10"},"PeriodicalIF":1.6,"publicationDate":"2000-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200003)3:1<3::AID-MHP68>3.0.CO;2-H","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72190168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-19DOI: 10.1002/1099-176X(200003)3:1<35::AID-MHP69>3.0.CO;2-I
Douglas L. Leslie, Robert Rosenheck, William D. White
<div> <section> <h3> Background:</h3> <p>Both private and public health care systems have embraced capitated reimbursement as a method of controlling costs.</p> </section> <section> <h3> Aims of the Study:</h3> <p>This study explores the financial implications of using reimbursement models based on clinically based patient classification schemes to distribute funds for the treatment of mental health patients in the Department of Veterans Affairs (VA).</p> </section> <section> <h3> Methods:</h3> <p>We identified 53700 veterans treated in VA specialty mental health outpatient clinics during the first 2 weeks of fiscal year (FY) 1991 for whom relevant clinical data were available. We calculated total utilization and costs for this sample during the remainder of FY 1991 using VA administrative databases and simulated hypothetical distributions of funds based on seven alternative capitation models. The resulting distributions of funds across service networks and facility types were compared to actual expenditures.</p> </section> <section> <h3> Results:</h3> <p>Approximately 8% of overall VA budget was redistributed under a simple capitated scheme, and some individual networks and facility types experienced changes in funding of over 30%. Models based on clinical data resulted in only minor differences from average-cost reimbursement. Substantial variation in practice style was observed across Veterans Integrated Service Networks (VISNs), which was significantly associated with funding shifts under capitation.</p> </section> <section> <h3> Discussion:</h3> <p>A simple capitated payment scheme would result in large changes in funding for some VISNs. Adjustments for case mix did not substantially affect patterns of redistribution. Patterns of redistribution appear to reflect large differences in practice style across VISNs. Although a capitated system will create incentives to reduce such variation, the effect of such shifts on patient well-being is unknown.</p> </section> <section> <h3> Implications for Health Policies:</h3> <p>Any capitated system will create incentives to provide a uniform standard of care. In our analyses, the capitation rate was based on the average cost per treated patient in each category; however rates could be set higher or lower as policy makers deem necessary. The standard of care associated with the average cost is not necessarily the ‘correct’ level of care.</p> </section> <section> <h
{"title":"Capitated payments for mental health patients: a comparison of potential approaches in a public sector population","authors":"Douglas L. Leslie, Robert Rosenheck, William D. White","doi":"10.1002/1099-176X(200003)3:1<35::AID-MHP69>3.0.CO;2-I","DOIUrl":"https://doi.org/10.1002/1099-176X(200003)3:1<35::AID-MHP69>3.0.CO;2-I","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background:</h3>\u0000 \u0000 <p>Both private and public health care systems have embraced capitated reimbursement as a method of controlling costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims of the Study:</h3>\u0000 \u0000 <p>This study explores the financial implications of using reimbursement models based on clinically based patient classification schemes to distribute funds for the treatment of mental health patients in the Department of Veterans Affairs (VA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods:</h3>\u0000 \u0000 <p>We identified 53700 veterans treated in VA specialty mental health outpatient clinics during the first 2 weeks of fiscal year (FY) 1991 for whom relevant clinical data were available. We calculated total utilization and costs for this sample during the remainder of FY 1991 using VA administrative databases and simulated hypothetical distributions of funds based on seven alternative capitation models. The resulting distributions of funds across service networks and facility types were compared to actual expenditures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>Approximately 8% of overall VA budget was redistributed under a simple capitated scheme, and some individual networks and facility types experienced changes in funding of over 30%. Models based on clinical data resulted in only minor differences from average-cost reimbursement. Substantial variation in practice style was observed across Veterans Integrated Service Networks (VISNs), which was significantly associated with funding shifts under capitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion:</h3>\u0000 \u0000 <p>A simple capitated payment scheme would result in large changes in funding for some VISNs. Adjustments for case mix did not substantially affect patterns of redistribution. Patterns of redistribution appear to reflect large differences in practice style across VISNs. Although a capitated system will create incentives to reduce such variation, the effect of such shifts on patient well-being is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implications for Health Policies:</h3>\u0000 \u0000 <p>Any capitated system will create incentives to provide a uniform standard of care. In our analyses, the capitation rate was based on the average cost per treated patient in each category; however rates could be set higher or lower as policy makers deem necessary. The standard of care associated with the average cost is not necessarily the ‘correct’ level of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 1","pages":"35-44"},"PeriodicalIF":1.6,"publicationDate":"2000-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200003)3:1<35::AID-MHP69>3.0.CO;2-I","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72157721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-19DOI: 10.1002/1099-176X(200003)3:1<56::AID-MHP82>3.0.CO;2-U
Ella Rytik
Please see the PDF file for the abstracts translations in Russian.
请参阅PDF文件中的摘要俄语翻译。
{"title":"Abstracts translations","authors":"Ella Rytik","doi":"10.1002/1099-176X(200003)3:1<56::AID-MHP82>3.0.CO;2-U","DOIUrl":"https://doi.org/10.1002/1099-176X(200003)3:1<56::AID-MHP82>3.0.CO;2-U","url":null,"abstract":"<p>Please see the PDF file for the abstracts translations in Russian.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 1","pages":"56-58"},"PeriodicalIF":1.6,"publicationDate":"2000-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200003)3:1<56::AID-MHP82>3.0.CO;2-U","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72157707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-19DOI: 10.1002/1099-176X(200003)3:1<45::AID-MHP71>3.0.CO;2-1
Per Bernhard Pedersen, Solfrid Lilleeng
<div> <section> <h3> Background:</h3> <p>During the last decades, a central aim of Norwegian health policy has been to achieve a more equal geographical distribution of services. Of special interest is the 1980 financial reform. Central government reimbursements for the treatment of in-patients were replaced by a block grant to each county, based on indicators of relative ‘need’.</p> </section> <section> <h3> Aims of the study:</h3> <p>The aim of this paper is to assess whether the distribution of specialized mental health services did take the course suggested by the proponents of the reform (i.e. a more equal distribution), or the opposite (i.e. a more unequal distribution) as claimed by the opponents.</p> </section> <section> <h3> Methods:</h3> <p>Man year <i>per capita</i> ratios were used as indicators for the distribution of mental health services by county. Ratios were estimated for ‘all personnel’, and for MDs and psychologists separately. Man years were assigned to counties by <i>location</i> of services (i.e. in which county the services were produced), and by <i>residence</i> of users (i.e. in which county the services were consumed). Indicators of geographic variation were estimated using the standard deviation (STD) as a measure of <i>absolute variation</i>, and the coefficient of variation (CV) and the Gini index as indicators of <i>relative variation</i>. Indicators were estimated for 1979, 1984, 1989 and 1994, based on data for all specialized adult mental health services in the country. Changes in distributions over the period were tested, using Levene's test of homogeneity.</p> </section> <section> <h3> Results:</h3> <p>Relative variations in the distribution of personnel by <i>location of services</i> were substantially reduced over the period, the CV being reduced by more than 50% for all groups. Variations in the personnel ratios by <i>residence of users</i> were smaller at the start of the period, and the reductions were also smaller. Still, relative variations were reduced by 20–35, 40 and 60% approximately for ‘all personnel’, MDs and psychologists respectively. In spite of a major increase in the supply of MDs and psychologists, <i>absolute</i> variations in the personnel ratios were in all cases either reduced, or fairly stable.</p> <p>These results give little support to the views expressed by the opponents of the 1980 reform, although the main result seems to have been relocations in the <i>production of services</i>, more than re-distributions in the <i>consumption of services</i>.</p> </section> <section> <h3> D
{"title":"Resource distribution in mental health services: changes in geographic location and use of personnel in Norwegian mental health services 1979–1994","authors":"Per Bernhard Pedersen, Solfrid Lilleeng","doi":"10.1002/1099-176X(200003)3:1<45::AID-MHP71>3.0.CO;2-1","DOIUrl":"https://doi.org/10.1002/1099-176X(200003)3:1<45::AID-MHP71>3.0.CO;2-1","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background:</h3>\u0000 \u0000 <p>During the last decades, a central aim of Norwegian health policy has been to achieve a more equal geographical distribution of services. Of special interest is the 1980 financial reform. Central government reimbursements for the treatment of in-patients were replaced by a block grant to each county, based on indicators of relative ‘need’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims of the study:</h3>\u0000 \u0000 <p>The aim of this paper is to assess whether the distribution of specialized mental health services did take the course suggested by the proponents of the reform (i.e. a more equal distribution), or the opposite (i.e. a more unequal distribution) as claimed by the opponents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods:</h3>\u0000 \u0000 <p>Man year <i>per capita</i> ratios were used as indicators for the distribution of mental health services by county. Ratios were estimated for ‘all personnel’, and for MDs and psychologists separately. Man years were assigned to counties by <i>location</i> of services (i.e. in which county the services were produced), and by <i>residence</i> of users (i.e. in which county the services were consumed). Indicators of geographic variation were estimated using the standard deviation (STD) as a measure of <i>absolute variation</i>, and the coefficient of variation (CV) and the Gini index as indicators of <i>relative variation</i>. Indicators were estimated for 1979, 1984, 1989 and 1994, based on data for all specialized adult mental health services in the country. Changes in distributions over the period were tested, using Levene's test of homogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>Relative variations in the distribution of personnel by <i>location of services</i> were substantially reduced over the period, the CV being reduced by more than 50% for all groups. Variations in the personnel ratios by <i>residence of users</i> were smaller at the start of the period, and the reductions were also smaller. Still, relative variations were reduced by 20–35, 40 and 60% approximately for ‘all personnel’, MDs and psychologists respectively. In spite of a major increase in the supply of MDs and psychologists, <i>absolute</i> variations in the personnel ratios were in all cases either reduced, or fairly stable.</p>\u0000 \u0000 <p>These results give little support to the views expressed by the opponents of the 1980 reform, although the main result seems to have been relocations in the <i>production of services</i>, more than re-distributions in the <i>consumption of services</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> D","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 1","pages":"45-53"},"PeriodicalIF":1.6,"publicationDate":"2000-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200003)3:1<45::AID-MHP71>3.0.CO;2-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72190170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-19DOI: 10.1002/1099-176X(200003)3:1<27::AID-MHP67>3.0.CO;2-P
Barbara Dickey, Hocine Azeni, Roger Weiss, Lloyd Sederer
Objectives:
This study compared medical treatment costs of adults with schizophrenia to adults with both substance use disorders and schizophrenia.
Methods:
This cross-sectional observational study used a paid claims data base to identify 6884 adults treated for schizophrenia. Twenty percent of these also had substance use disorder. We report the costs and likelihood of hospitalization for eight common medical diseases, and the categories of injuries and poisoning, and ill defined conditions. Multivariate analyses were used to adjust rates of treatment for age and sex differences in the comparison groups.
Results:
There were higher rates of treatment for five of the eight medical disorders, higher treatment costs for two of the medical disorders and much higher costs for psychiatric treatment among those with comorbid substance use disorders. Both groups had high rates of treatment in the categories of injury and poisoning and ill defined conditions.
Pub Date : 2000-05-31DOI: 10.1002/(SICI)1099-176X(199912)2:4<183::AID-MHP62>3.0.CO;2-1
Allison A Roberts Dr
<p><b>Background</b>: This study examines the impact of mental illness on the labor market performance of family members of afflicted individuals. Numerous research projects have attempted to measure the impact of mental illness and related disorders on the ill individual, yet have traditionally neglected estimating potential costs accruing to family members of the ill.<b>Aims of the Study</b>: Previous research estimating the impact of illness on the time allocation decisions of family caregivers has been limited in scope. I obtain estimates of the impact of mental illness on the probability of labor force participation and hours of work of all family members. The general analysis used in this study will pave the way for more accurate assessments of the costs of <i>all</i> types of illness and the estimates obtained will provide policy makers with a much more complete picture of the costs of mental illness.<b>Methods</b>: The main empirical work in this study includes a probit estimation of labor force participation and a tobit regression of hours worked (including sample selection correction). The data sample, taken from the 1987 National Medical Expenditure Survey, is also partitioned by gender to clarify effects of family illness on labor supply for both females and males.<b>Results</b>: Adult males are found to <i>increase</i> their probability of labor force participation in the presence of mental illness in the family (all else equal) when the mental illness is accompanied by a chronic physical illness. However, females are surprisingly found to have no significant impact on their probability of being a member of the labor market when a family member is afflicted with mental illness. On the other hand, hours of work are significantly <i>reduced</i> for both females and males when the mentally ill family member is afflicted with additional illnesses (physical and/or mental).<b>Discussion</b>: Previous studies have traditionally not considered the effects of family illness on males because females are typically found to be the primary caregiver when a family member falls ill. The findings in this study indicate that men suffer reductions in their hours of work in an equivalent magnitude to females. Thus, males should <i>not</i> be ignored when estimating the opportunity costs of illness in families.<b>Implications for Health Policies</b>: Current federal and state policies provide for some of the medical costs and replace some of the lost income of ill individuals, but generally do not support family members who are negatively affected by illness. This research provides evidence supporting the arguments of advocates for policy to ameliorate the financial burden borne by family members of the ill.<b>Implications for Future Research</b>: The estimates obtained in this study show that women and men both need to be studied when determining the effects of family illness on labor supply, and should be studied separately to obtain clear results. Al
{"title":"The labor market consequences of family illness","authors":"Allison A Roberts Dr","doi":"10.1002/(SICI)1099-176X(199912)2:4<183::AID-MHP62>3.0.CO;2-1","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199912)2:4<183::AID-MHP62>3.0.CO;2-1","url":null,"abstract":"<p><b>Background</b>: This study examines the impact of mental illness on the labor market performance of family members of afflicted individuals. Numerous research projects have attempted to measure the impact of mental illness and related disorders on the ill individual, yet have traditionally neglected estimating potential costs accruing to family members of the ill.<b>Aims of the Study</b>: Previous research estimating the impact of illness on the time allocation decisions of family caregivers has been limited in scope. I obtain estimates of the impact of mental illness on the probability of labor force participation and hours of work of all family members. The general analysis used in this study will pave the way for more accurate assessments of the costs of <i>all</i> types of illness and the estimates obtained will provide policy makers with a much more complete picture of the costs of mental illness.<b>Methods</b>: The main empirical work in this study includes a probit estimation of labor force participation and a tobit regression of hours worked (including sample selection correction). The data sample, taken from the 1987 National Medical Expenditure Survey, is also partitioned by gender to clarify effects of family illness on labor supply for both females and males.<b>Results</b>: Adult males are found to <i>increase</i> their probability of labor force participation in the presence of mental illness in the family (all else equal) when the mental illness is accompanied by a chronic physical illness. However, females are surprisingly found to have no significant impact on their probability of being a member of the labor market when a family member is afflicted with mental illness. On the other hand, hours of work are significantly <i>reduced</i> for both females and males when the mentally ill family member is afflicted with additional illnesses (physical and/or mental).<b>Discussion</b>: Previous studies have traditionally not considered the effects of family illness on males because females are typically found to be the primary caregiver when a family member falls ill. The findings in this study indicate that men suffer reductions in their hours of work in an equivalent magnitude to females. Thus, males should <i>not</i> be ignored when estimating the opportunity costs of illness in families.<b>Implications for Health Policies</b>: Current federal and state policies provide for some of the medical costs and replace some of the lost income of ill individuals, but generally do not support family members who are negatively affected by illness. This research provides evidence supporting the arguments of advocates for policy to ameliorate the financial burden borne by family members of the ill.<b>Implications for Future Research</b>: The estimates obtained in this study show that women and men both need to be studied when determining the effects of family illness on labor supply, and should be studied separately to obtain clear results. Al","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 4","pages":"183-195"},"PeriodicalIF":1.6,"publicationDate":"2000-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199912)2:4<183::AID-MHP62>3.0.CO;2-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71988597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-05-31DOI: 10.1002/(SICI)1099-176X(199912)2:4<169::AID-MHP65>3.0.CO;2-T
Michael G. Madianos, Costas Zacharakis, Chryssa Tsitsa, Costas Stefanis
<p><b>Background</b>: In Greece, the functional capacity of the mental health care system until 1980, was totally inadequate to meet the increasing mental health needs of the population and to provide efficient and community-based services. This situation was brought to the attention of the Commission of European Communities and a special EEC Regulation No 815/84 provided the financial technical support for an extended psychiatric reform programme. The psychiatric reform programme initiated in 1984 and ended in 1995.<b>Aims of the study</b>: This study compared the geographical distribution of neuropsychiatrists and the mental health care delivery system structural components (psychiatric beds, extramural mental health units and places in rehabilitation services), according to the regional socioeconomic development for the years 1984, 1990 and 1996. Additionally the possible effects of the operation of community-based mental health services on the psychiatric hospitalizations were examined.<b>Methods</b>: Data on the geographical distribution of neuropsychiatrists in the previously mentioned years were drawn from local Medical Association from each of 54 prefectures of the country. The corresponding distribution of the mental health care delivery system components was made available from the database of the Monitoring and Evaluation of Mental Health Services Unit. Pearson product moment correlations of the regional distribution of neuropsychiatrists and the various components of the mental health care system, as population-based ratios, with the corresponding socioeconomic development in the form of the general index of development were performed. Mental hospital age standardized rates were collected from the Hospital Central Register for the periods 1984–1987 and 1990–1993. Discharge rates were elaborated according to the existence of mental health services in specific regions.<b>Results</b>: A wide regional variation in neuropsychiatrists per 100000 population was found in all three years, with the majority of them working in the greater Athens and Thessaloniki areas. In the geographical distribution of health regions, there is an uneven significant decrease in psychiatric beds between 1984 and 1996. However in almost all regions an increase in extramural services between the two critical periods was noticed, as part of the implementation of the psychiatric reform programme. A parallel and more dramatic increase in the places of rehabilitation in 12 out of 13 regions has been observed during the implementation of the reform programme. At the level of prefectures, the changes across time, in the mean ratios of beds, extramural services and rehabilitation places were not found to be significant.</p><p>A significant decrease of discharges in prefectures covered by newly established extramural services for the period 1990–1993, compared to discharge rates during the period 1984–1987, when none of these services were in operation in these prefecture
{"title":"The mental health care delivery system in greece: regional variation and socioeconomic correlates","authors":"Michael G. Madianos, Costas Zacharakis, Chryssa Tsitsa, Costas Stefanis","doi":"10.1002/(SICI)1099-176X(199912)2:4<169::AID-MHP65>3.0.CO;2-T","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199912)2:4<169::AID-MHP65>3.0.CO;2-T","url":null,"abstract":"<p><b>Background</b>: In Greece, the functional capacity of the mental health care system until 1980, was totally inadequate to meet the increasing mental health needs of the population and to provide efficient and community-based services. This situation was brought to the attention of the Commission of European Communities and a special EEC Regulation No 815/84 provided the financial technical support for an extended psychiatric reform programme. The psychiatric reform programme initiated in 1984 and ended in 1995.<b>Aims of the study</b>: This study compared the geographical distribution of neuropsychiatrists and the mental health care delivery system structural components (psychiatric beds, extramural mental health units and places in rehabilitation services), according to the regional socioeconomic development for the years 1984, 1990 and 1996. Additionally the possible effects of the operation of community-based mental health services on the psychiatric hospitalizations were examined.<b>Methods</b>: Data on the geographical distribution of neuropsychiatrists in the previously mentioned years were drawn from local Medical Association from each of 54 prefectures of the country. The corresponding distribution of the mental health care delivery system components was made available from the database of the Monitoring and Evaluation of Mental Health Services Unit. Pearson product moment correlations of the regional distribution of neuropsychiatrists and the various components of the mental health care system, as population-based ratios, with the corresponding socioeconomic development in the form of the general index of development were performed. Mental hospital age standardized rates were collected from the Hospital Central Register for the periods 1984–1987 and 1990–1993. Discharge rates were elaborated according to the existence of mental health services in specific regions.<b>Results</b>: A wide regional variation in neuropsychiatrists per 100000 population was found in all three years, with the majority of them working in the greater Athens and Thessaloniki areas. In the geographical distribution of health regions, there is an uneven significant decrease in psychiatric beds between 1984 and 1996. However in almost all regions an increase in extramural services between the two critical periods was noticed, as part of the implementation of the psychiatric reform programme. A parallel and more dramatic increase in the places of rehabilitation in 12 out of 13 regions has been observed during the implementation of the reform programme. At the level of prefectures, the changes across time, in the mean ratios of beds, extramural services and rehabilitation places were not found to be significant.</p><p>A significant decrease of discharges in prefectures covered by newly established extramural services for the period 1990–1993, compared to discharge rates during the period 1984–1987, when none of these services were in operation in these prefecture","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 4","pages":"169-176"},"PeriodicalIF":1.6,"publicationDate":"2000-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199912)2:4<169::AID-MHP65>3.0.CO;2-T","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72170245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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