Physical Health Care Costs Research Articles

Costs for physical and mental health hospitalizations in the first 13 years of life among children engaged with Child Protection Services

BackgroundLongitudinal data on health costs associated with physical and mental conditions are not available for children reported to child protection services. ObjectiveTo estimate the costs of hospitalization for physical and mental health conditions by child protection status, including out-of-home-care (OOHC) placement, from birth until 13-years, and to assess the excess costs associated with child protection contact over this period. Participants and settingAustralian population cohort of 79,285 children in a multi-agency linkage study. MethodsCosts of hospitalization were estimated from birth (if available) using Round 17, National Hospital Cost Data Collection (2012-13; deflated to 2015-16 AUD). Records of the state child protection authority determined contact status. Data were reported separately for children in OOHC. Hospital separations were classified as mental disorder-related if the primary diagnosis was recorded in ICD-10 Chapter V (F00-F99). ResultsHospital separations were more common in children with child protection contact. Physical health care costs per child decreased with age for all children, but were significantly higher for children with contact. Mental health costs per child were always significantly higher for children with contact, with marked increases at 3 ≤ 4 years and 8 ≤ 9 years. Point estimates of annual costs per child were always highest for children with an OOHC placement. The net present value of the excess costs was $3,224 per child until 13- years, discounted at 5 %. ConclusionsChildren in contact with child protection services show higher rates and costs for physical and mental health hospitalizations in each of their first 13 years of life.

M49 EPIGENOME-WIDE ASSOCIATION STUDY (EWAS) OF YOUNG PEOPLE WITH FAMILIAL RISK OF BIPOLAR DISORDER

Longitudinal data on health costs associated with physical and mental conditions are not available for children reported to child protection services.To estimate the costs of hospitalization for physical and mental health conditions by child protection status, including out-of-home-care (OOHC) placement, from birth until 13-years, and to assess the excess costs associated with child protection contact over this period.Australian population cohort of 79,285 children in a multi-agency linkage study.Costs of hospitalization were estimated from birth (if available) using Round 17, National Hospital Cost Data Collection (2012-13; deflated to 2015-16 AUD). Records of the state child protection authority determined contact status. Data were reported separately for children in OOHC. Hospital separations were classified as mental disorder-related if the primary diagnosis was recorded in ICD-10 Chapter V (F00-F99).Hospital separations were more common in children with child protection contact. Physical health care costs per child decreased with age for all children, but were significantly higher for children with contact. Mental health costs per child were always significantly higher for children with contact, with marked increases at 3 ≤ 4 years and 8 ≤ 9 years. Point estimates of annual costs per child were always highest for children with an OOHC placement. The net present value of the excess costs was $3,224 per child until 13- years, discounted at 5 %.Children in contact with child protection services show higher rates and costs for physical and mental health hospitalizations in each of their first 13 years of life.

The Association between Depressive Symptoms and Physical Diseases in Switzerland: A Cross-Sectional General Population Study.

Objective: To estimate the association between depressive symptoms and physical diseases in Switzerland, as respective findings might inform about future estimates of mental and physical health care costs.Methods: A population-based study, using data from the Swiss Health Survey collected by computer-assisted telephone interviews and additional written questionnaires during the year 2007 (n = 18,760) in Switzerland. The multistage stratified random sample included subjects aged 15 years and older, living in a private Swiss household with a telephone connection. Complete data were available for 14,348 subjects (51% of all subjects reached by telephone). Logistic regression analyses were used to estimate the associations between depressive symptoms and any physical disease, or a specific physical disease out of 13 non-communicable physical diseases assessed with a self-report checklist on common physical diseases. Analyses were adjusted for sex, age, education, occupation, and household income.Results: In the adjusted models, depressive symptoms were associated with arthrosis and arthritis [Odds Ratio (OR) = 1.79, 95% confidence interval (CI) = 1.28-2.50] and any physical disease (OR = 1.67, 95% CI = 1.33-2.10) after controlling for multiple testing.Conclusion: Our findings contribute to a better understanding of the comorbidity of depressive symptoms and arthrosis and arthritis in Switzerland and might have implications for more precise future estimates of mental and physical health care costs.

APA Educates Employers on Value Of Mentally Healthy Workforce

Back to table of contents Previous article Next article The Medical Director's DeskFull AccessAPA Educates Employers on Value Of Mentally Healthy WorkforceJames H. Scully Jr., M.D.James H. Scully Jr.Search for more papers by this author, M.D.Published Online:6 Aug 2004https://doi.org/10.1176/pn.39.15.0390004 Why is it important to provide mental health resources for employees? How will it really affect our company's bottom line? These are just some of the questions that the National Partnership for Workplace Mental Health routinely addresses with employers around the country.The National Partnership for Workplace Mental Health is a public education program of the American Psychiatric Foundation in collaboration with APA and America's employers. The workplace partnership, founded in 2001, develops and supports educational efforts for employers to generate a better understanding of the benefits of a mentally healthy workforce, early recognition of mental disorders, effective treatment, and appropriate access to quality mental health care. The workplace partnership also serves as a forum for partners to share innovative strategies for addressing mental health issues.Among its founding partners are large companies such as AT&T, Coca-Cola, Delta Air Lines, and Dow Chemical; business organizations including the Society for Human Resource Management and the U.S. Chamber of Commerce; and government agencies such as the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration.The workplace partnership was created because businesses purchase 50 percent of all health care in the United States and also influence federal, state, and local government purchasing. Thus, employers have the ability to leverage their buying power to improve the mental health of employees and their families.Research shows that when companies invest in their employees' mental health, the bottom line improves through decreased physical health care costs, reduced short- and long-term disability costs, and lower absenteeism rates. The return on investment is even more dramatic when productivity gains are factored in. Healthy employees mean increased productivity and effectiveness for businesses. An economic analysis comparing depression treatment costs with lost productivity costs found that 45 percent to 98 percent of treatment costs were offset by increased productivity, according to R.C. Kessler and colleagues in “Depression in the Workplace: Effects on Short-Term Disability,” published in Health Affairs in 1999. There is indeed a “business case for providing quality mental health care.”Since the program's inception, the workplace partnership has successfully created print and Web-based educational material and resources for employers and employees including a brochure related to disasters that has been distributed to nearly a million employees. The workplace partnership has also co-developed a highly successful quarterly newsletter, Mental HealthWorks, which reaches 26,000 business leaders and psychiatrists.The workplace partnership is working with the National Business Coalition on Health to survey business coalitions across the country regarding their attitudes toward, interest in, and activities related to mental health issues. The survey results will directly inform program activities and the development of educational materials.In addition, the workplace partnership recently joined with APA to introduce an exciting new tool to raise awareness of depression in the workplace. The Depression Calculator is an online tool at<www.depressioncalculator.com> (see Original article: page 30) that enables employers to estimate the costs and productivity savings they could reap if employees suffering from depression receive effective treatment. The workplace partnership, along with the U.S. Chamber of Commerce, the Institute of Health and Productivity Management, the Mid-America Coalition on Healthcare, and the Pharmaceutical Research and Manufacturers of America, is publicizing the availability of this tool to employers.The workplace partnership is part of a growing stable of programs and activities in the American Psychiatric Foundation. As a charitable and educational subsidiary of APA, the foundation's mission is to advance public understanding that mental illnesses are real and can be effectively treated. The foundation is entirely supported by private contributions, which fund initiatives that are making unique and important contributions to psychiatry, such as the workplace partnership.To receive a free subscription to Mental HealthWorks, send an e-mail to [email protected] with “free subscription” in the subject line. In the body of the e-mail, include your mailing address, phone number, and specify whether you would like to receive the publication by mail or e-mail.To learn more about the National Partnership for Workplace Mental Health, please visit<www.workplacementalhealth.org> or contact its director, Clare Miller, by phone at (703)-907-8673 or by e-mail at [email protected]. Information about the foundation, including details for donating, are posted at<www.psychfoundation.org>.Feel free to share your thoughts, comments, and suggestions with me at medical [email protected].▪ ISSUES NewArchived

Placement Stability and Mental Health Costs for Children in Foster Care

Although prior population-based studies have found that children in foster care use more mental health services than their Medicaid peers, less is known about how different experiences in foster care impact the likelihood of mental health service use. The primary aim of this study is to test the hypothesis that instability of foster care placements is associated with higher costs for mental health care services. The secondary aim is to test the hypothesis that foster care children are also more likely to generate high costs for mental health services if they generate higher costs for non-mental health claims. Using administrative child welfare data linked to Medicaid claims, we assembled a unique retrospective cohort of adjudicated dependent children >2 years old who entered foster care between July 1993 and June 1995, spent at least 9 months in care, and were Medicaid eligible during a 1-year follow-up period. The primary outcome was high mental health service use, defined as having costs in the top decile of the sample. The primary independent variables were the number of foster care placements during the year and whether placements were interrupted by a return home for at least 1 month during that year (episodic foster care). We used logistic regression to estimate the association between placements and service utilization, with adjustment for age and physical health care costs. Of the 1635 children in the study, 41% had > or = 3 foster care placements, and 5% had episodic foster care during the year of observation. The top 10% of mental health service users accounted for 83% of the 2.4 million dollars in mental health costs. Both multiple placements and episodic foster care increased the predicted probability of high mental health service use. Higher physical health care costs also increased the probability of high mental health use for all children, but this increased probability was most dramatic among children with episodic foster care (probability of high mental health use: 0.78; 95% confidence interval: 0.42-0.94). Foster care placement instability was associated with increased mental health costs during the first year in foster care, particularly among children with increasing general health care costs. These findings highlight the importance of interventions that address the global health of children in foster care and may permit better targeting of health care resources to subgroups of children most likely to use services.

A Dual Diagnosis Demonstration Project: Treatment Outcomes and Cost Analysis

This article presents findings from an outpatient dual diagnosis demonstration project that investigated whether integrated treatment services for severely and persistently ill patients with co-occurring mental health and substance abuse disorders could result in improved outcomes and reduction of criminal justice and health care costs. Integrated treatment was defined as a simultaneous focus on both disorders through the provision of psychosocial rehabilitation, psychotherapeutic and psychopharmacologic treatment, and substance abuse recovery and relapse prevention by crosstrained staff. One hundred twenty six (126) patients with multiple DSM-IV Axis I and Axis II disorders were assessed on a variety of mental health, substance abuse, and quality of life measures at baseline and at six-month intervals up to three years post entry into treatment. Criminal justice and health care costs obtained from state and local databases were compared two years before and two years after initiation of treatment to determine cost differences. The study found statistically significant improvements in psychiatric symptoms, substance abuse, and quality of life outcomes. There were also decreases in criminal justice and acute and sub-acute mental health and alcohol and other drug (AOD) costs and increases in outpatient mental health and physical health care costs.

The business case for quality mental health services: why employers should care about the mental health and well-being of their employees.

Employers are very concerned about rising mental health care costs. They want to know whether their health care spending is improving the health of workers, and whether there is a productivity payback from providing good mental health care. This article addresses the subject of employee depression and its impact on business. The literature suggests that depressed individuals exert a significant cost burden for employers. Evidence is mounting that worker depression may have its greatest impact on productivity losses, including increased absenteeism and short-term disability, higher turnover, and suboptimal performance at work. Although there is no conclusive evidence yet that physical health care costs decrease when depression is effectively treated, there is growing evidence that productivity improvements occur as a consequence of effective treatment, and those improvements may offset the cost of the treatment.

Comment on Chiles et al.

Research continues to increasingly demonstrate a medical cost offset whereby psychological interventions reduce medical care utilization and physical health care costs. Third-party payers in health care, however, remain skeptical that additional costs for psychological services will eventually result in overall cost savings for them. This commentary identifies some of the obstacles in the current health care system that prevent a medical cost offset from being realized and describes remedies to those obstacles.