Out-of-pocket health expenditures in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders: findings from a study in a psychiatry outpatient clinic in Turkey

Işlek, Duygu; Kiliç, Bülent; Akdede, Berna Binnur

doi:10.1007/s00127-017-1465-y

Cited by 6 publications

(14 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A deeper knowledge of clinical and social traits would have explained some of the findings more clearly. Third, information about treatments supplied by private organisations or facilities, as well as non-reimbursable payments, were not available from our databases (Pauly et al, 2016;Islek et al, 2018), and we could not account for these interventions in our analyses. Therefore, it should be underlined that our findings only focus on services supplied by public facilities.…”

Section: Discussionmentioning

confidence: 99%

The quality of mental health care delivered to patients with schizophrenia and related disorders in the Italian mental health system. The QUADIM project: a multi-regional Italian investigation based on healthcare utilisation databases

Lora

Compagnoni

Allevi³

et al. 2022

Epidemiol Psychiatr Sci

View full text Add to dashboard Cite

Aims To evaluate the quality of mental health care delivered to patients with schizophrenia and related disorders taken-in-care by mental health services in four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). Methods Thirty-one clinical indicators concerning accessibility, appropriateness, continuity and safety were defined and estimated using healthcare utilisation (HCU) databases, containing data on mental health treatments, hospital admissions, outpatient interventions, lab tests and drug prescriptions. Results A total of 70 586 prevalent patients with schizophrenia and related disorders treated in 2015 were identified, of whom 1752 were newly taken-in-care by the facilities of regional mental health services. For most patients community care was accessible and moderately intensive. However, care pathways were not implemented based on a structured assessment and only half of the patients received psychosocial treatments. One patient out of ten had access to psychological interventions and psychoeducation. Activities specifically addressed to families involved a third of prevalent patients and less than half of new patients. One patient out of six was admitted to a community residential facility, and one out of ten to a General Hospital Psychiatric Ward (GHPW); higher values were identified in new cases. In general hospitals, few patients had a length of stay (LoS) of more than 30 days, while one-fifth of the admissions were followed by readmission within 30 days of discharge. For two-thirds of patients, continuity of community care was met, and six times out of ten a discharge from a GHPW was followed by an outpatient contact within 2 weeks. For cases newly taken-in-care, the continuity of community care was uncommon, while the readiness of outpatient contacts after discharge was slightly more frequent. Most of the patients received antipsychotic medication, but their adherence to long-term treatment was low. Antipsychotic polytherapy was frequent and the control of metabolic side effects was poor. The variability between regions was high and consistent in all the quality domains. Conclusions The Italian mental health system could be improved by increasing the accessibility to psychosocial interventions, improving the quality of care for newly taken-in-care patients, focusing on somatic health and mortality, and reducing regional variability. Clinical indicators demonstrate the strengths and weaknesses of the mental health system in these regions, and, as HCU databases, they could be useful tools in the routine assessment of mental healthcare quality at regional and national levels.

show abstract

Section: Discussionmentioning

confidence: 99%

The quality of mental health care delivered to patients with schizophrenia and related disorders in the Italian mental health system. The QUADIM project: a multi-regional Italian investigation based on healthcare utilisation databases

Lora

Compagnoni

Allevi³

et al. 2022

Epidemiol Psychiatr Sci

View full text Add to dashboard Cite

show abstract

“…Third, both exposure and outcome misclassification likely affected our estimates. Common sources of exposure misclassification include treatments delivered by private services or office-based practices, as well as out-of-pocket payments for healthcare services [27,28]. However, since misclassification of mental healthcare coverage likely occurs irrespectively from experiencing relapse (i.e., being likely that a no-differential misclassification occurs [29]), unbiased estimates are expected.…”

Section: Discussionmentioning

confidence: 99%

Does the mental health system provide effective coverage to people with schizophrenic disorder? A self-controlled case series study in Italy

Corrao

Barbato

D’Avanzo

et al. 2021

Soc Psychiatry Psychiatr Epidemiol

View full text Add to dashboard Cite

Purpose To measure indicators of timeliness and continuity of treatments on patients with schizophrenic disorder in ‘real-life’ practice, and to validate them through their relationship with relapse occurrences. Methods The target population was from four Italian regions overall covering 22 million beneficiaries of the NHS (37% of the entire Italian population). The cohort included 12,054 patients newly taken into care for schizophrenic disorder between January 2015 and June 2016. The self-controlled case series (SCCS) design was used to estimate the incidence rate ratio of relapse occurrences according to mental healthcare coverage. Results Poor timeliness (82% and 33% of cohort members had not yet started treatment with psychosocial interventions and antipsychotic drug therapy within the first year after they were taken into care) and continuity (27% and 23% of patients were persistent with psychosocial interventions, and antipsychotic drug therapy within the first 2 years after starting the specific treatment) were observed. According to SCCS design, 4794 relapses occurred during 9430 PY (with incidence rate of 50.8 every 100 PY). Compared with periods not covered by mental healthcare, those covered by psychosocial intervention alone, antipsychotic drugs alone and by psychosocial intervention and antipsychotic drugs together were, respectively, associated with relapse rate reductions of 28% (95% CI 4–46%), 24% (17–30%) and 44% (32–53%). Conclusion Healthcare administrative data may contribute to monitor and to assess the effectiveness of a mental health system. Persistent use of both psychosocial intervention and antipsychotic drugs reduces risk of severe relapse.

show abstract

“…Some studies further classify out‐of‐pocket spending data 10 ,. 13 , 26 , 34 , 45–49 A separate group of studies examines expenditures associated with a specific disease 24 , 37 , 50 , 51 or such services as child care, maternal care, prenatal care, or maternity 52–55 …”

Section: Literature Reviewmentioning

confidence: 99%

“…The employed are more likely to incur OOP expenditures than the unemployed, 42 that is, unemployed OOP expenditures are lower 39 . However, some studies find that the unemployed have higher out‐of‐pocket expenditures on healthcare 9,24 …”

Section: Literature Reviewmentioning

confidence: 99%

“…Out‐of‐pocket spending on healthcare is the primary source of financing next to public health expenditures in terms of the amount and percentage of total expenditures in most countries 23 . OOP expenditures, referring to the payments made by households in exchange for healthcare services, have been increasing in the last 2 decades in Turkey 24 . OOP payments for treatment, pharmaceuticals, and other services and supplies reached 28,655 billion Turkish lira, increasing by 19.4% in 2018 alone.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Determinants of Turkish households' out‐of‐pocket expenditures on three categories of health care services: A multivariate probit approach

Demir

Alkan

Bilgiç

et al. 2022

Health Planning & Management

View full text Add to dashboard Cite

This study identifies the driving forces that contribute to the probabilities of incidence of out-of-pocket (OOP) expenditures by households in Turkey. Factors affecting the probability of OOP expenditures on medical products/devices/ supplies (MP), outpatient services (OTS), and inpatient services (ITS) are examined using the Household Budget Survey data gathered by the Turkish Statistical Institute in 2018. The study applies the multivariate probit model.The incidence of OOP spending varied with 48.9% of the households reporting OOP expenditure on MP, 22.4% on OTS, and 25.4% on ITS. The largest probability changes were associated with household disposable annual income, household type and size, age category, and having private health insurance. Gender and marital status also influenced expenditures in some categories. Lifestyle choices had small and mixed effects, with smoking and alcohol consumption lowering the probability of OOP spending. From a policy standpoint, households with the lowest incomes, large households, and those where the household head was 'others' (retiree, student, housewife, not actively working, etc.) or had a condition preventing employment seemed to report OOP expenditures less frequently and may have chosen not to receive healthcare services, leading to the need for more healthcare services later.

show abstract

Out-of-pocket health expenditures in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders: findings from a study in a psychiatry outpatient clinic in Turkey

Cited by 6 publications

References 12 publications

The quality of mental health care delivered to patients with schizophrenia and related disorders in the Italian mental health system. The QUADIM project: a multi-regional Italian investigation based on healthcare utilisation databases

The quality of mental health care delivered to patients with schizophrenia and related disorders in the Italian mental health system. The QUADIM project: a multi-regional Italian investigation based on healthcare utilisation databases

Does the mental health system provide effective coverage to people with schizophrenic disorder? A self-controlled case series study in Italy

Determinants of Turkish households' out‐of‐pocket expenditures on three categories of health care services: A multivariate probit approach

Contact Info

Product

Resources

About