Money matters: does the reimbursement policy for second-generation antipsychotics influence the number of recorded schizophrenia patients and the burden of stigmatization?

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Abstract

Purpose

In Poland, non-compliance with the reimbursement policy for second-generation antipsychotics (SGA) manifested in prescribing SGA for patients with psychotic disorders other than schizophrenia may result in serious financial penalties. In this study, we aimed at investigating whether the implementation of the reimbursement policy for SGA contributed to increasing the number of patients with a diagnosis of schizophrenia relatively to the number of patients with a diagnosis of other psychotic disorders in outpatient clinics.

Methods

We analyzed data from Yearbooks of Mental Health that were published by the Institute of Psychiatry and Neurology, Warsaw, Poland in the years 1989–2009 registering the number of patients treated for various mental disorders in public facilities in Poland. Temporal trend analysis of the annual number of patients with a diagnosis of psychotic disorders, who were treated at outpatient clinics, was performed.

Results

We found a statistically significant increase in the total number of recorded schizophrenia patients treated at outpatient clinics, as well as in the number of patients treated for the first time at outpatient clinics for schizophrenia. These changes overlap with the implementation of the reimbursement policy for SGA.

Conclusion

Our results suggest that the restricted reimbursement policy for SGA altered the diagnosing process in Poland. It seems that these alterations may have serious social consequences. Given that a diagnosis of schizophrenia is more stigmatizing than a diagnosis of other psychotic disorders, it might be assumed that schizophrenia over-diagnosing, possibly due to reimbursement reasons, add to the enormous burden associated with stigmatization.

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Most cited references 17

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Recent systematic reviews have encouraged the psychiatric research community to reevaluate the contours of schizophrenia epidemiology. This paper provides a concise overview of three related systematic reviews on the incidence, prevalence, and mortality associated with schizophrenia. The reviews shared key methodological features regarding search strategies, analysis of the distribution of the frequency estimates, and exploration of the influence of key variables (sex, migrant status, urbanicity, secular trend, economic status, and latitude). Contrary to previous interpretations, the incidence of schizophrenia shows prominent variation between sites. The median incidence of schizophrenia was 15.2/100,000 persons, and the central 80% of estimates varied over a fivefold range (7.7-43.0/100,000). The rate ratio for males:females was 1.4:1. Prevalence estimates also show prominent variation. The median lifetime morbid risk for schizophrenia was 7.2/1,000 persons. On the basis of the standardized mortality ratio, people with schizophrenia have a two- to threefold increased risk of dying (median standardized mortality ratio = 2.6 for all-cause mortality), and this differential gap in mortality has increased over recent decades. Compared with native-born individuals, migrants have an increased incidence and prevalence of schizophrenia. Exposures related to urbanicity, economic status, and latitude are also associated with various frequency measures. In conclusion, the epidemiology of schizophrenia is characterized by prominent variability and gradients that can help guide future research.

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Evidence from nearly a century of epidemiological research indicates that schizophrenia occurs in all populations with a prevalence in the range of 1.4 to 4.6 per 1000 and incidence rates in the range of 0.16-0.42 per 1000 population. Multi-centre studies conducted by the World Health Organization have highlighted important differences between 'Western' and 'Third World' populations as regards the course and outcome of the disorder, with a significantly better prognosis in the developing countries. The factors underlying the better outcome of schizophrenia in developing countries remain essentially unknown but are likely to involve interactions between genetic variation and specific aspects of the environment. These features place schizophrenia, along with diabetes, cancer and hypertension, into the group of genetically complex diseases which are characterised by polygenic transmission, locus heterogeneity and environmental contribution to causation. The emerging pattern of risk factors and antecedents of schizophrenia suggests multiple, mainly quantitative deviations from the average developmental trajectory, primarily in the areas of early neurodevelopment, cognitive ability and social behaviour. These deviations are compatible with the notion of non-specific background factors facilitating the operation of genetically determined causal pathways. Research likely to result in new insights should focus on the population distribution and behavioural effects of potential risk factors and markers suggested by biological and genetic research.

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Anticipated and experienced stigma among people with schizophrenia: its nature and correlates.

Matthias Angermeyer, Anna Bielańska, Andrzej Cechnicki (2011)

In recent years, there has been a growing awareness of the stigma experienced by people with mental illnesses and their families. The aim of this study is to assess the amount of stigma anticipated and experienced by schizophrenia patients in one region of Poland and to examine how these figures relate to socio-demographic and clinical correlates. Subjective stigmatisation was assessed using the Inventory of Stigma Experiences of Psychiatric Patients. The mental health centres in Malopolska selected for the study were facilities representative of the whole region as regards location and type of treatment. Out of 250 patients contacted, 202 participated in the study, resulting in a response rate of 80.8%. The majority of respondents anticipated discrimination in interpersonal contacts (58%) as well as in the area of employment (55%). The most common experiences of discrimination in interpersonal interactions were the feeling of rejection by other people (87%) and having had an interpersonal contact broken off (50%). Participants living in highly urbanised areas more frequently anticipated exclusion of the mentally ill from the labour market, and older participants more often expressed the view that the mentally ill may have difficulties with access to institutions. The experience of structural discrimination was associated with lower education levels, living in a city, unemployment, being female, and being separated or widowed. The experience of rejection in interpersonal interaction was associated with lower education levels and more hospitalisations, and the experience of a negative public image of the mentally ill with unemployment and more hospitalisations. (1) In southern Poland, people with schizophrenia both anticipated and experienced the strongest stigma in the domains of interpersonal relationships and employment. (2) Anticipated stigma, contrary to experienced stigma, shows hardly any correlation with patients' specific socio-demographic and clinical characteristics.

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Author and article information

Contributors

Blazej Misiak: +48-71-7841600 , +48-71-7841602 , mblazej@interia.eu

Journal

Journal ID (nlm-ta): Soc Psychiatry Psychiatr Epidemiol

Journal ID (iso-abbrev): Soc Psychiatry Psychiatr Epidemiol

Title: Social Psychiatry and Psychiatric Epidemiology

Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )

ISSN (Print): 0933-7954

ISSN (Electronic): 1433-9285

Publication date (Electronic): 11 September 2013

Publication date PMC-release: 11 September 2013

Publication date (Print): 2014

Volume: 49

Pages: 531-539

Affiliations

[ ]Department of Psychiatry, Wroclaw Medical University, 10 Pasteur Street, 50-367 Wrocław, Poland

[ ]Institute of Information Science and Engineering, Wroclaw University of Technology, 10 Wyspianski Street, 50-370 Wrocław, Poland

Article

Publisher ID: 763

DOI: 10.1007/s00127-013-0763-2

PMC ID: 3969810

PubMed ID: 24022754

SO-VID: 2f382e60-b875-43be-a510-f6ec22725d46

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.