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

Published online by Cambridge University Press:  18 May 2011

Laura Grigoletti ,
Francesco Amaddeo ,
Aldrigo Grassi ,
Massimo Boldrini ,
Marco Chiappelli ,
Mauro Percudani ,
Francesco Catapano ,
Andrea Fiorillo ,
Luca Bartoli  and
Maurizio Bacigalupi
...Show all authors
Laura Grigoletti*
Affiliation:
Dipartimento di Medicina e Sanita Pubblica, Sezione di Psichiatria e Psicologia Clinica, Università di Verona, Verona
Francesco Amaddeo
Affiliation:
Dipartimento di Medicina e Sanita Pubblica, Sezione di Psichiatria e Psicologia Clinica, Università di Verona, Verona
Aldrigo Grassi
Affiliation:
Centro di Salute Mentale “Scalo”, Bologna
Massimo Boldrini
Affiliation:
Centro di Salute Mentale “Scalo”, Bologna
Marco Chiappelli
Affiliation:
Centro di Salute Mentale “Scalo”, Bologna
Mauro Percudani
Affiliation:
Dipartimento di Salute Mentale di Legnano, Milano
Francesco Catapano
Affiliation:
Centro di Salute Mentale “Scalo”, Bologna
Andrea Fiorillo
Affiliation:
Dipartimento di Psichiatria, Seconda Universita di Napoli, Napoli
Luca Bartoli
Affiliation:
Dipartimento di Salute Mentale ASL Roma B, Roma
Maurizio Bacigalupi
Affiliation:
Dipartimento di Salute Mentale ASL Roma B, Roma
Paolo Albanese
Affiliation:
Dipartimento di Salute Mentale ASL Roma B, Roma
Simona Simonetti
Affiliation:
Dipartimento di Scienze Economiche, Università di Verona, Verona
Federico Perali
Affiliation:
Dipartimento di Scienze Economiche, Università di Verona, Verona
Paola De Agostini
Affiliation:
Dipartimento di Scienze Economiche, Università di Verona, Verona
Michele Tansella
Affiliation:
Dipartimento di Medicina e Sanita Pubblica, Sezione di Psichiatria e Psicologia Clinica, Università di Verona, Verona
*
Address for correspondence: Dr. L. Grigoletti, Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria e Psicologia Clinica, Ospedale Policlinico “G.B. Rossi”, P.le L.A. Scuro 10, 37134 Verona Fax: +39-045-8074889 E-mail: [email protected]
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Summary

Aims – 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

Keywords

mental health servicesfinancial managementeconomic models
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 15 , Issue 4 , December 2006 , pp. 295 - 306
Copyright
Copyright © Cambridge University Press 2006

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References

Bibliografia

Amaddeo, F. & Bonizzato, P. (1999). Verso un nuovo sistema di finanziamento dei servizi psichiatrici. Epidemiologia e Psichiatria Sociale 8, 5–10.CrossRefGoogle Scholar
Amaddeo, F., Bacigalupi, M., de Girolamo, G., Di Munzio, W., Lora, A. & Semisa, D. (1998). Attivita, Interventi e Strutture del Dipartimento di Salute Mentale. Epidemiologia e Psichiatria Sociale, Suppl. 7, 3–36.Google Scholar
Amaddeo, F., Bisoffi, G., Bonizzato, P. & Tansella, M. (2000). Exploring the relationships between patients' characteristics and costs of community-based mental health care. Mental Health Research Review 7, 28–32.Google Scholar
Babigian, H.M., Cole, R.E., Reed, S.K., Brown, S.W. & Lehman, A.F. (1991). Methodology for evaluating the Monroe-Livingston capitation system. Hospital and Community Psychiatry 42, 913–919.Google ScholarPubMed
Bindman, J., Glover, G., Goldberg, D. & Chisholm, D. (2000). Expenditure on mental health care by English health authorities: a potential cause of inequity. British Journal of Psychiatry 177:267–74.CrossRefGoogle ScholarPubMed
Bloom, J.R., Hu, T.T., Wallace, N., Cuffel, B., Hausman, J. & Scheffler, R. (1998). Mental health costs and outcomes under alternative capitation systems in Colorado: early results. Journal of Mental Health Policy and Economics 1, 3–13.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
Bonizzato, P., Bisoffi, G., Amaddeo, F., Chisholm, D. & Tansella, M. (2000). Community-based mental health care: to what extent are service costs associated with clinical, social and service history variables? Psychological Medicine 30, 1205–1215.CrossRefGoogle ScholarPubMed
Cole, R.E., Reed, S.K., Babigian, H.M., Brown, S.W. & Fray, J. (1994). A mental health capitation program: I. Patient outcomes. Hospital and Community Psychiatry 45, 1090–1096.Google ScholarPubMed
De Agostini, P., Bonizzato, P., Amaddeo, F., Bisoffi, G., Perali, F. & Tansella, M. (2001). Per un piu razionale sistema di finanziamento dei Dipartimenti di Salute Mentale, Analisi dei costi delle prestazioni erogate da un Servizio Psichiatrico Territoriale in un periodo di 7 anni. Epidemiologia e Psichiatria Sociale 10, 163–179.CrossRefGoogle Scholar
Fattore, G., Percudani, M., Pugnoli, C. & Contini, A. (1997). I costi delle prestazioni in psichiatria: un'analisi condotta in un Centra Psico-Sociale (CPS) pubblico in Lombardia. Epidemiologia e Psichiatria Sociale 6, 139–147.CrossRefGoogle Scholar
Grassi, A., Bruni, R., Pileggi, F., Chiappelli, M., Boldrini, M., Franceschi, E. & Scarafoni, D. (2001). Analisi e valutazioni comparative dei costi dei trattamenti terapeutico-riabilitativi delle psicosi schizofreniche, delle psicosi affettive, della paranoia e dei disturbi nevrotici. Epidemiologia e Psichiatria Sociale 10, 115–124.CrossRefGoogle Scholar
Hosmer, D.W. & Lemeshow, S. (1989). Applied Logistic Regression. Wiley: New York.Google Scholar
Langiewicz, W. & Slupczynska-Kossobudzka, E. (2000). Organization and financing of mental health care in Poland. Journal of Mental Health Policy and Economics 3, 77–81.3.0.CO;2-S>CrossRefGoogle ScholarPubMed
Magliano, L., Fiorillo, A., Malangone, C., Aletti, A., Belotti, G., Bevilacqua, P., le Femine, A.L., Fontana, G., Maucioni, F., Travi, M., Zanus, P., Rossi, A. & Maj, M. (1998). Carico familiare nella schizofrenia: effetto delle variabili cliniche e socio-ambientali e degli interventi familiari. Epidemiologia e Psichiatria Sociale 7, 178–187.CrossRefGoogle Scholar
McCrone, P. & Strathdee, G. (1994). Needs not diagnosis: towards a more rational approach to community mental health resourcing in Britain. International Journal of Social Psychiatry 40, 79–86.CrossRefGoogle Scholar
McDaid, D, Knapp, M, Curran, C; The MHEEN Group. (2006) Meeting the challenge of funding and allocating resources to mental health across Europe: developing the Mental Health Economics European Network. Epidemiologia e Psichiatria Sociale 15(2), 117–122.CrossRefGoogle Scholar
Mental Health Branch. (1997). National Mental Health Report 1996: Fourth Annual Report, Changes in Australia's Mental Health Services under the National Mental Health Strategy 1995-96. Commonwealth Department of Health and Family Services: Canberra.Google Scholar
Moos, R.H., McCoy, L. & Moos, B.S. (2000). Global assessment of functioning (GAF) ratings: determinants and role as predictors of one-year treatment outcomes. Journal of Clinical Psychology 56, 449–461.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
Munizza, C., Donna, G. & Nieddu, S. (1999) Finanziamento e Management del Dipartimento di Salute Mentale. II Mulino: Bologna.Google Scholar
Reed, S.K., Hennessy, K.D., Mitchell, O.S. & Babigian, H.M. (1994). A mental health capitation program: II. Cost-benefit analysis. Hospital and Community Psychiatry 45, 1097–1103.Google ScholarPubMed
Saraceno, B. & Saxena, S.(2005). Mental health services in Central and Eastern Europe: current state and continuing concerns. Epidemiologia e Psichiatria Sociale 14(1), 44–48.CrossRefGoogle ScholarPubMed
Schreter, R.K. (1997). Psychiatric care for the 21st century. Psychiatric Services 48, 1245–1246.Google Scholar
Sharfstein, S.S. (1991). Prospective cost allocations for the chronic schizophrenic patient. Schizophrenia Bulletin 17, 395–400.CrossRefGoogle ScholarPubMed
Smith, P., Sheldon, T.A. & Martin, S. (1996). An index of need for psychiatric services based on in-patient utilisation. British Journal of Psychiatry 169, 308–316.CrossRefGoogle ScholarPubMed
Tansella, M., Bisoffi, G. & Thornicroft, G. (1993). Are social deprivation and psychiatric service utilisation associated in neurotic disorders? A case register study in south Verona. Social Psychiatry and Psychiatric Epidemiology 28, 225–230.CrossRefGoogle ScholarPubMed
Thornicroft, G., Bisoffi, G., De, S.D. & Tansella, M. (1993). Urban-rural differences in the associations between social deprivation and psychiatric service utilization in schizophrenia and all diagnoses: a case-register study in Northern Italy. Psychological Medicine 23, 487–496.CrossRefGoogle ScholarPubMed