Proposal for a new funding system for mental health departments. Results from an evaluative multicentre Italian study (I-psycost)

Abstract

SummaryAims – To obtain a new, well-balanced mental health funding system, through the creation of i) a list of psychiatric interventions provided by Italian Community-based Psychiatric Services (CPS), and associated costs; ii) a new prospective funding system for patients with a high use of resources, based on packages of care. Methods – Five Italian Community-based Psychiatric Services collected data from 1250 patients during October 2002. Socio-demographical and clinical characteristics and GAF scores were collected at baseline. All psychiatric contacts during the following six months were registered and categorised into 24 service contact types. Using elasticity equation and contact characteristics, we estimate the costs of care. Cluster analysis techniques identified packages of care. Logistic regression defined predictive variables of high use patients. Multinomial Logistic Model assigned each patient to a package of care. Results – The sample's socio-demographic characteristics are similar, but variations exist between the different CPS. Patients were then divided into two groups, and the group with the highest use of resources was divided into three smaller groups, based on number and type of services provided. Conclusions – Our findings show how is possible to develop a cost predictive model to assign patients with a high use of resources to a group that can provide the right level of care. For these patients it might be possible to apply a prospective per-capita funding system based on packages of care.Declaration of Interest: None

A predictive model to allocate frequent service users of community-based Mental Health Services to different packages of care

“…The frequent service users group was then subjected to a cluster analysis to identify packages of care, each package being homogeneous in terms of service utilisation, and different from the others in terms of costs, taking into account administrative needs, medical knowledge and statistical analysis. More details on these procedures are given in Grigoletti et al (2006).…”

Development and spatial representation of synthetic indexes of outpatient mental health care in Andalusia (Spain)

“…In the next future evidence-base planning in mental health care should be based on decision support systems which incorporate synthetic indexes, packages of care, related costs and GIS (Salvador-Carulla et al, 2006;Grigoletti et al, 2006). In the next future evidence-base planning in mental health care should be based on decision support systems which incorporate synthetic indexes, packages of care, related costs and GIS (Salvador-Carulla et al, 2006;Grigoletti et al, 2006).…”

Clinical and sociodemographic features associated with the high and prolonged utilization of resources by outpatients of a Community Psychiatric Service

“…Le sottoscale della BPRS non vengono presentate per motivi di spazio, ma saranno a disposizione del lettore interessato su richiesta. Rispetto alia globalita del campione i dati non differiscono sostanzialmente rispetto a quelli presenti in letteratura sugli alti utilizzatori dei servizi (Kent et al, 1995;Lora et al, 1998;Grigoletti et al, 2006, Mustard et al, 1996, in particolare per quanto concerne l'associazione tra disturbi psicotici (Kent et al, 1995;Tansella et al, 1986;Mustard et al, 1996) e disturbi di personalita (Bender et al, 2006) ed alto utilizzo di risorse. Quindi a distanza di 20 anni dalle prime ricerche nel campo (Tansella et al, 1986), l'elevata presenza di Psicosi tra i soggetti con elevato e prolungato utilizzo del servizio e confermata, mentre aumenta l'incidenza dei Disturbi di Personalita.…”

“…A disconferma di precedenti evidenze si rileva una scarsa influenza della rete sociale sull'alto utilizzo (Grigoletti et al, 2006;Tello et al, 2005). Infatti, nel campione di alti utilizzatori solo 4 pazienti su 35 vivono da soli.…”

“…Tra le variabili associate a pattern di utilizzo elevato e prolungato, alcuni studi hanno sottolineato l'importanza di fattori di ordine sociale (Kent et al, 1995;Grigoletti et al, 2006), quali la mancanza di supporto sociale e di una abitazione, o lo stato socio economico in genere (Amaddeo & Jones, 2007;Tansella et al, 1986); altre variabili individuate sono la presenza di disturbi psicotici, la comorbidita con disturbi di personality e l'abuso di alcool e sostanze (Mustard et al, 1996;Kent et al, 1995;Roick et al, 2002). Un recente studio (Bender et al, 2006) ha esaminato 1'utilizzo dei trattamenti nei servizi di salute mentale in un periodo di tre anni da parte di pazienti con Disturbi di Personality (DP) e di pazienti depressi senza DP.…”