Abstract
BACKGROUND: Information about unit costs of psychiatric care is largely unavailable in Central and Eastern Europe, which poses an obstacle to economic evaluations as well as evidence-based development of the care in the region.
OBJECTIVE: The objective of this study was to calculate the unit costs of inpatient and community mental health services in Czechia and to assess the current practices of data collection by mental healthcare providers.
METHODS: We used bottom-up microcosting to calculate unit costs from detailed longitudinal accounts and records kept by three psychiatric hospitals and three community mental health providers.
RESULTS: An inpatient day in a psychiatric hospital costs 1504 Czech koruna (CZK; €59), out of which 75% is consumed by hotel services and the rest by medication and therapies. The costed inpatient therapies include individual therapies provided by a psychiatrist or psychologist, consultations with a social worker, group therapies, organised cultural activities and training activities. As regards the community setting, we costed daycare social facilities, case management services, sheltered housing, supported housing, crisis help, social therapeutic workshops, individual placement and support, and self-help groups.
CONCLUSIONS: The unit costs enable assigning financial value to individual items monitored by the Czech version of the Client Service Receipt Inventory, and thus estimation of costs associated with treatment of mental health problems. The employed methodology might serve as a guideline for the providers to improve data collection and to calculate costs of services themselves, with this information likely becoming more crucial for payers in the future.
| Original language | English |
|---|---|
| Pages (from-to) | 287-298 |
| Journal | Applied health economics and health policy |
| Volume | 18 |
| Issue number | 2 |
| Early online date | 26 Jul 2019 |
| DOIs | |
| Publication status | Published - 2019 |
| Externally published | Yes |
Funding
The authors are grateful to all participating providers: the psychiatric hospitals Bohnice, Petrohrad and Opava as well as to the community centres Fokus Mladá Boleslav, Fokus Praha and Fokus Opava. Special thanks go to our colleague Markéta Bejdová for her research on community centres. The Psychiatric Care Reform Strategy (‘Strategy’) commissioned and approved by the Ministry of Health in 2013 introduces a vision for further development of psychiatric care in Czechia. The overall aim of the Strategy is to enhance the quality of life of people with mental health problems; its specific aims are destigmatisation and humanisation of mental health, higher effectivity, social inclusion of people with mental health problems, and establishment of a coherent social and healthcare system []. The implementation of the Strategy proceeds through ten nation-wide projects led by three key institutions: the Ministry of Health, the National Institute of Mental Health, and the Institute of Health Information and Statistics. The implementation projects are financed by the European Structural Funds. To achieve sustainability of the reform, the decision-making process should ensure that only cost-effective care is funded, for which reliable data—including cost data—are required. The system of Czech psychiatric care in fact consists of two subsystems. First, psychiatric services provided in hospitals or by outpatient psychiatrists form a part of the healthcare system. This care is covered by obligatory insurance and the services are primarily paid for by insurance companies. A list of hospital and ambulatory reimbursements paid by insurance companies is issued yearly by the Ministry of Health of the Czech Republic, which acts as the competent regulator. Nevertheless, being largely shaped by the interests of care providers and insurers involved in their negotiations, the reimbursement rates do not accurately reflect opportunity costs of resources spent on healthcare. The Czech healthcare market is, similarly to most healthcare markets around the globe, far from perfectly competitive, which is a condition for the prices to reflect the opportunity costs []. Second, community psychiatric services fall within the social care system. These services are usually funded by local governments, or receive financial support from the European Social Funds, Norwegian Funds or other sources. In general, this dual approach to psychiatric services causes difficulties in coordination, organisation and funding.
| Funders | Funder number |
|---|---|
| Bohnice, Petrohrad and Opava | |
| Fokus Mladá Boleslav | |
| Fokus Praha and Fokus Opava | |
| Ministry of Social Affairs of the Czech Republic | |
| Norwegian Funds | |
| National Institute of Mental Health | LO1611 |
| Ministerstvo Školství, Mládeže a Tělovýchovy | X/0.0/0.0/15_124/0006067, CZ.033 |
| European Social Fund |