Adaptation of activity-based-costing (ABC) to calculate unit costs in Mental Health Care in Spain

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Abstract

Background: To date, numerous cost-of-illness studies have been using methodologies that don't provide trustworthy results for decision making in mental health care. Objectives: The aims of this paper are design and implement a cost methodology by process of patient's care to calculate unit costs in mental health in Spain in 2005 and compare the results with the reached ones by traditional methods. Methods: We adapted Activity-Based-Costing to this field analyzing the organizational and management structure of Mental Health's public services in a region of Spain, Navarre, describing the processes of care to patient in each resource and calculating their cost. Results: We implemented this methodology in all resources and obtained unit cost per service. There are great differences between our results and the ones calculated by traditional systems. We display one example of these disparities contrasting our cost with the reached one by the methodology of Diagnostic Related Group (DRG). Conclusions: This cost methodology offers more advantages for management than traditional methods provide.

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The global costs of schizophrenia.

Martin Knapp, Judit Simon, Roshni Mangalore (2003)

Schizophrenia is a chronic disease associated with a significant and long-lasting health, social, and financial burden, not only for patients but also for families, other caregivers, and the wider society. Many national and local studies have sought to estimate the societal burden of the illness--or some components of it--in monetary terms. Findings vary. We systematically reviewed the literature to locate all existing international estimates to date. Sixty-two relevant studies were found and summarized. Within- and between-country differences were analyzed descriptively. Despite the wide diversity of data sets and methods applied, all cost-of-illness estimates highlight the heavy societal burden of schizophrenia. Such information helps us to understand the health, health care, economic, and policy importance of schizophrenia, and to better interpret and explain the large within- and across-country differences that exist.

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Cost of care of schizophrenia: a study of Indian out-patient attenders.

A Bhansali, P. Kulhara, Kalyan S. Chakrabarti … (2005)

To assess the cost of care of Indian out-patients with schizophrenia. Cost of illness in 50 out-patients with schizophrenia was assessed over a 6-month period together with structured assessments of psychopathology and disability, and compared with 50 out-patients with diabetes mellitus. Total annual costs of care of schizophrenia were 274 US dollars; these were not significantly different from diabetes mellitus. Indirect costs (63%) were higher than direct costs. Drug costs were high. The main brunt of financial burden was borne by the family. Total treatment costs in schizophrenia were significantly higher in those who were unemployed, those who visited the hospital more often, and were more severely ill and disabled. Schizophrenia is an expensive illness to treat even in developing countries. Costs of care are similar to those of chronic physical illness, such as diabetes mellitus. Costs are higher in severely ill and disabled patients. Copyright Blackwell Munksgaard 2005.

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Costs of schizophrenia and other psychoses in urban Australia: findings from the Low Prevalence (Psychotic) Disorders Study.

T Lewin, V. Carr, Elizabeth S. Halpin … (2003)

To estimate the costs associated with the treatment and care of persons with psychosis in Australia based on data from the Low Prevalence Disorders Study (LPDS), and to identify areas where there is potential for more efficient use of existing health care resources. The LPDS was a one-month census-based survey of people with psychotic disorders in contact with mental health services, which was conducted in four metropolitan regions in 1997-1998. Mental health and service utilization data from 980 interviews were used to estimate the economic costs associated with psychotic disorders. A prevalence-based, 'bottom-up' approach was adopted to calculate the government and societal costs associated with psychosis, including treatment and non-treatment related costs. Annual societal costs for the average patient with psychosis are of the order of 46,200 Australian dollars , comprising 27,500 Australian dollars in lost productivity, 13,800 Australian dollars in inpatient mental health care costs and 4900 Australian dollars in other mental health and community services costs. Psychosis costs the Australian government at least 1.45 billion Australian dollars per annum, while societal costs are at least 2.25 billion Australian dollars per annum (including 1.44 billion Australian dollars for schizophrenia). We also report relationships between societal costs and demographic factors, diagnosis, disability and participation in employment. Current expenditure on psychosis in Australia is probably inefficient. There may be substantial opportunity costs in not delivering effective treatments in sufficient volume to people with psychotic disorders, not intervening early, and not improving access to rehabilitation and supported accommodation.