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Cost drivers of inpatient mental health care: a systematic review

Published online by Cambridge University Press:  16 December 2013

J. Wolff ,
P. McCrone ,
L. Koeser ,
C. Normann  and
A. Patel
J. Wolff*
Affiliation:
King's College London, Institute of Psychiatry, Health Service and Population Research, CEMPH, London, UK Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Freiburg im Breisgau, Germany
P. McCrone
Affiliation:
King's College London, Institute of Psychiatry, Health Service and Population Research, CEMPH, London, UK
L. Koeser
Affiliation:
King's College London, Institute of Psychiatry, Health Service and Population Research, CEMPH, London, UK
C. Normann
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Freiburg im Breisgau, Germany
A. Patel
Affiliation:
King's College London, Institute of Psychiatry, Health Service and Population Research, CEMPH, London, UK
*
*Address for correspondence: J. Wolff, Department of Psychiatry and Psychotherapy, University Medical Centre Freiburg, Hugstetter Straße 49, 79106 Freiburg im Breisgau, Germany. (Email: [email protected])
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Abstract

Aims.

New reimbursement schemes for inpatient mental health care are imminent in the UK and Germany. The shared intention is to reflect cost differences between patients in reimbursement rates. This requires understanding of patient characteristics that influence hospital resource use. The aim of this review was to show which associations between mental health care per diem hospital costs and patient characteristics are supported by current evidence.

Methods.

A systematic review of the literature published between 1980 and 2012 was carried out. The search strategy included electronic databases and hand-searching. Furthermore, reference lists, citing articles and related publications were screened and experts were contacted.

Results.

The search found eight studies. Dispersion in per diem costs was moderate, as was the ability to explain it with patient characteristics. Six patient characteristics were identified as the most relevant variables. These were (1) age, (2) major diagnostic group, (3) risk, (4) legal problems, (5) the ability to perform activities of daily living and (6) presence of psychotic or affective symptoms. Two non-patient-related factors were identified. These were (1) day of stay and (2) treatment site.

Conclusions.

Idiosyncrasies of mental health care complicated the prediction of per diem hospital costs. More research is required in European settings since transferability of results is unlikely.

Keywords

Cost analysishospitalsmental disordersprospective payment system
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 24 , Issue 1 , February 2015 , pp. 78 - 89
Copyright
Copyright © Cambridge University Press 2013 

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References

Autio, S (1987). The relationship between patient characteristics and inpatient psychiatric nurse resource utilization. NLN Publications 20, 319–330.Google Scholar
Barbui, C, Tansella, M (2012). Guideline implementation in mental health: current status and future goals. Epidemiology and Psychiatric Sciences 21, 227–229.Google Scholar
Breiman, L, Friedman, J, Stone, CJ, Olshen, RA (1984). Classification and Regression Trees. Chapman and Hall: Boca Raton.Google Scholar
Buckingham, B, Burgess, P, Solomon, S (1998 a). Developing a Casemix Classification for Mental Health Services – Summary. Commonwealth Department of Health & Family Services: Canberra.Google Scholar
Buckingham, B, Burgess, P, Solomon, S, Pirkis, J, Eager, K (1998 b). Developing a Casemix Classification for Mental Health Services: Volume 1 Main Report. Commonwealth Department of Health & Family Services: Canberra.Google Scholar
Cotterill, PG, Thomas, FG (2004). Prospective payment for Medicare inpatient psychiatric care: assessing the alternatives. Health Care Financing Review 26, 85–101.Google ScholarPubMed
Cromwell, J, Maier, J (2006). Economic grand rounds: variation in staffing and activities in psychiatric inpatient units. Psychiatric Services 57, 772–774.Google Scholar
Cromwell, J, Maier, J, Gage, B, Drozd, E, Osber, D, Richter, E, Greenwald, L, Goldman, H (2004). Characteristics of high staff intensive Medicare psychiatric inpatients. Health Care Financing Review 26, 103–117.Google Scholar
Cromwell, J, Gage, B, Drozd, E, Maier, J, Osber, D, Evensen, C, Richter, E, Goldman, H (2005 a). Psychiatric Inpatient Routine Cost Analysis – Final Report. RTI International: Waltham.Google Scholar
Cromwell, J, Drozd, E, Gage, B, Maier, J, Richter, E, Goldman, H (2005 b). Variation in patient routine costliness in U.S. psychiatric facilities. Journal of Mental Health Policy and Economics 8, 15–28.Google Scholar
Daniel, I (2008). Grouper and Weighting Methodology for Adult Inpatient Mental Health Care in Ontario- Summary Report From The JPPC Mental Health Technical Working Group. Ontario Joint Policy and Planning Committee: Ontario.Google Scholar
Drozd, E, Cromwell, J, Gage, B, Maier, J, Greenwald, L, Goldman, H (2006). Patient casemix classification for medicare psychiatric prospective payment. American Journal of Psychiatry 163, 724–732.Google Scholar
Drummond, MF, Jefferson, TO (1996). Guidelines for authors and peer reviewers of economic submissions to the BMJ. British Medical Journal 313, 275–283.Google Scholar
Eagar, K, Gaines, P, Burgess, P, Green, J, Bower, A, Buckingham, B, Mellsop, G (2004). Developing a New Zealand casemix classification for mental health services. World Psychiatry 3, 172–177.Google ScholarPubMed
Essock, SM, Norquist, GS (1988). Toward a fairer prospective payment system. Archives of General Psychiatry 45, 1041–1044.Google Scholar
Evers, S, Goossens, M, de Vet, H, van Tulder, M, Ament, A (2005). Criteria list for assessment of methodological quality of economic evaluations: consensus on health economic criteria. International Journal of Technology Assessment in Health Care 21, 240–245.Google Scholar
Fries, BE, Schneider, DP, Foley, WJ, Dowling, M (1989). Case-mix classification of Medicare residents in skilled nursing facilities: Resource Utilization Groups (RUG-T18). Medical Care 27, 843–858.Google Scholar
Fries, BE, Nerenz, DR, Falcon, SP, Ashcraft, ML, Lee, CZ (1990). A classification system for long-staying psychiatric patients. Medical Care 28, 311–323.Google Scholar
Fries, BE, Durance, PW, Nerenz, DR, Ashcraft, ML (1993). A comprehensive payment model for short- and long-stay psychiatric patients. Health Care Financing Review 15, 31–50.Google Scholar
Fries, BE, Schneider, DP, Foley, WJ, Gavazzi, M, Burke, R, Cornelius, E (1994). Refining a case-mix measure for nursing homes: Resource Utilization Groups (RUG-III). Medical Care 32, 668–685.Google Scholar
Gaines, P, Bower, A, Buckingham, B, Eager, K, Green, J (2003). New Zealand Health Classification and Outcomes Study: Final Report. Health Research Council of New Zealand: Auckland.Google Scholar
Hirdes, JP, Fries, BE, Botz, C, Ensley, C, Marhaba, M, Pérez, E (2002). The System for Classification of In-Patient Psychiatry (SCIPP): a New Case-Mix Methodology for Mental Health. InterRAI: Waterloo.Google Scholar
Iglesias, C, Alonso Villa, MJ (2005). A system of patient classification in long-term psychiatric inpatients: Resource Utilization Groups T-18 (RUG T-18). Journal of Psychiatric and Mental Health Nursing 12, 33–37.Google Scholar
InEK (2010). Kalkulation von Behandlungsfallkosten- Handbuch zur Kalkulation psychiatrischer und psychosomatischer Leistungen in Einrichtungen nach §17d KHG. Institut für das Entgeltsystem im Krankenhaus: Siegburg.Google Scholar
Jencks, SF, Horgan, C, Taube, CA (1987). Evidence on provider response to prospective payment. Medical Care 25, 37–41.Google Scholar
Jensen, DD, Cohen, PR (2000). Multiple comparisons in induction algorithms. Machine Learning 38, 309–338.Google Scholar
Lave, JR (2003). Developing a Medicare prospective payment system for inpatient psychiatric care. Health Affairs 22, 97–109.Google Scholar
Lave, JR & Frank, RG (1990). Effect of the structure of hospital payment on length of stay. Health Services Research 25, 327–347.Google Scholar
McCrone, P (1994). Allocating resources in psychiatric hospitals according to casemix. Psychiatric Bulletin 18, 212–213.CrossRefGoogle Scholar
McCrone, P (1995). Predicting mental health service use: diagnosis based systems and alternatives. Journal of Mental Health 4, 31–40.Google Scholar
McCrone, P, Phelan, M (1994). Diagnosis and length of psychiatric in-patient stay. Psychological Medicine 24, 1025–1030.Google Scholar
McCrone, P, Leese, M, Thornicroft, G, Schene, A, Knudsen, HC, Vázquez-Barquero, JL, Tansella, M, Becker, T (2001). A comparison of needs of patients with schizophrenia in five European countries: the EPSILON Study. Acta Psychiatrica Scandinavica 103, 370–379.Google Scholar
Moreno, K (2007). Adaptation of activity-based-costing (ABC) to calculate unit costs in mental health care in Spain. European Journal of Psychiatry 21, 117–123.CrossRefGoogle Scholar
Payment by Results (2012). NHS Costing Manual. Department of Health: London.Google Scholar
Rupp, A, Steinwachs, DM, Salkever, DS (1984). The effect of hospital payment methods on the pattern and cost of mental health care. Hospital and Community Psychiatry 35, 456–459.Google Scholar
Suarez, M, Bravo-Ortiz, M, Fernandez-Liria, A, Gonzalez-Juarez, C (2011). Effectiveness of Continuity-of-Care Programs to reduce time in hospital in persons with schizophrenia. Epidemiology and Psychiatric Sciences 20, 65–72.Google Scholar
Tulloch, AD, Fearon, P, David, AS (2011). Length of stay of general psychiatric inpatients in the United States: systematic review. Administration and Policy in Mental Health 38, 155–168.Google Scholar
Wahlbeck, K (2011). European comparisons between mental health services. Epidemiology and Psychiatric Sciences 20, 15–18.Google Scholar
Weinmann, S, Koesters, M, Becker, T (2007). Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review. Acta Psychiatrica Scandinavica 115, 420–33.CrossRefGoogle ScholarPubMed
Yamauchi, K (1997 a). Designing a new payment system for psychiatric care – developing of a case-mix classification system. Journal of the Japanese Society on Hospital Administration 34, 155–200.Google Scholar
Yamauchi, K (1997 b). Designing a new payment system for psychiatric care – relationship between the costs on inpatient care and the revenue from insurances. Journal of the Japanese Society on Hospital Administration 34, 60–71.Google Scholar