Outpatient Psychotherapy Reduces Health-Care Costs: A Study of 22,294 Insurants over 5 Years.

Uwe Altmann,Dietmar Kramer,Helmut A Kirchmann,Anna Zimmermann,Bernhard M Strauss,Ellen Bruckmayer,Emma Auch,Irmgard Pfaffinger,Fritz Von Heymann,Rolf Steyer,Andrea Fembacher

doi:10.3389/fpsyt.2016.00098

Abstract

The project "Quality Assurance in Ambulatory Psychotherapy in Bavaria" (QS-PSY-BAY) focuses on the quality assurance of outpatient psychotherapy (OPT) in Germany in terms of symptom reduction and cost reduction under naturalistic conditions. In this study, we examined the effectiveness of psychotherapy in terms of pre-post cost reduction. The health-care costs of N = 22,294 insurants over a 5-year period were examined in a naturalistic longitudinal design. Six participating health insurance funds provided data on costs related to inpatient treatment, outpatient treatment, drugs, and hospitalization and work disability days. We found that the average annual total costs for inpatient and outpatient treatments as well as drug costs and work disability days increased from the second to the first year before OPT. Besides a large and significant reduction of work disability days (41.8%), hospitalization days (27.4%), and inpatient costs (21.5%) from the first year before versus the first year following OPT, we found evidence for long-term effects: the number of work disability days in the second year after OPT was lower (23.8%), and drug costs were higher than in the second year before OPT (41.5%). We conclude that OPT as a part of the health insurance system is an investment which can pay off in the future especially in terms of lower inpatient costs and work disability.

Highlights

Health services research focuses on medical and psychotherapeutic treatments under naturalistic conditions
We focused on outpatient psychotherapy (OPT) in Germany
Analyzing health insurance data of 22,294 persons with statutory health insurance, we examined inpatient costs, outpatient costs, drug costs, number of work disability days, and number of hospitalization days under naturalistic conditions

Summary

Introduction

Health services research focuses on medical and psychotherapeutic treatments under naturalistic conditions. Psychotherapy seems to be costeffective, the available reviews and meta-analyses usually refer to studies of health-care systems of different countries, various psychological approaches, and/or evaluations of different cost variables. The examination of the cost-effectiveness of psychotherapy is subject to the problem that studies come from various health services systems with different general conditions for OPT. The number of therapy sessions, e.g., provides one marked difference: in the USA, e.g., the median number of OPT sessions is 5, whereas in German, short-term psychotherapy comprises 25 sessions [9] For this reason, results related to therapy outcome or its cost-effectiveness are not directly comparable between countries. The project “Quality Assurance in Ambulatory Psychotherapy in Bavaria” (QS-PSY-BAY) focuses on the quality assurance of outpatient psychotherapy (OPT) in Germany in terms of symptom reduction and cost reduction under naturalistic conditions. We examined the effectiveness of psychotherapy in terms of pre–post cost reduction

Methods

Results

Conclusion