Abstract
BackgroundThe Netherlands has few financial barriers to access mental healthcare. However, in 2012, a sharp rise in co-payments was introduced.AimsWe tested whether these increased co-payments coincided with less guideline-recommended continuous out-patient psychiatric care and more crisis interventions for patients with bipolar disorder.MethodA retrospective longitudinal cohort study on a health insurance registry was performed to examine trends, and deviations from these trends, in the healthcare received by patients with bipolar disorder. Deviations of trends were tested by time-series analyses (autoregressive integrated moving average). Subsequently, the relationship between significant deviations of trends and rise in co-payments was examined. Outcome measures were the level of standard out-patient care (out-patient psychiatric care and/or medication), crisis psychiatric care and somatic care.ResultsThe cohort comprised 3210 patients. During follow-up, the use of psychiatric care decreased and somatic care increased. The high rise in co-payments from 2012 onward coincided with decreases in standard out-patient care and increases in medication-only treatment, crisis psychiatric care and somatic care. Crisis intervention was highest when patients received only bipolar disorder medication. Patients receiving continuous standard out-patient care (62%) had less crisis intervention compared with the other patients.ConclusionsOur data suggest that the rise of co-payments decreased guideline-recommended continuous out-patient psychiatric care among patients with bipolar disorder, and increased crisis psychiatric care.
Highlights
The Netherlands has few financial barriers to access mental healthcare
Patients receiving continuous standard out-patient care (62%) had less crisis intervention compared with the other patients
Our data suggest that the rise of co-payments decreased guideline-recommended continuous out-patient psychiatric care among patients with bipolar disorder, and increased crisis psychiatric care
Summary
A retrospective longitudinal cohort study on a health insurance registry was performed to examine trends, and deviations from these trends, in the healthcare received by patients with bipolar disorder. All patients with a diagnosis of bipolar disorder in 2008, under 70 years of age on 1 January 2008, and insured by Zilveren Kruis from 2008 to 2014, were selected and analysed in a retrospective cohort study. A period with few co-payments (2009–2011) was followed by a period (2012–2014) with a high rise in general co-payments and a co-payment for specialised mental healthcare (applied only in 2012) Using this design, trends in care and deviations of these trends in relation to the extent of co-payments could be analysed. Zilveren Kruis compared their data with national data.[28,29] All mental and somatic healthcare use, including prescription data of medication for bipolar disorder, of these patients over 2009–2014 were analysed
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