Date Published: December 15, 2017
Publisher: Springer US
Author(s): Kasper van Mens, Joran Lokkerbol, Richard Janssen, Mirjam L. van Orden, Margot Kloos, Bea Tiemens.
Over the last decade, the Dutch mental healthcare system has been subject to profound policy reforms, in order to achieve affordable, accessible, and high quality care. One of the adjustments was to substitute part of the specialized care for general mental healthcare. Using a quasi-experimental design, we compared the cost-effectiveness of patients in the new setting with comparable patients from specialized mental healthcare in the old setting. Results showed that for this group of patients the average cost of treatment was significantly reduced by, on average, €2132 (p < 0.001), with similar health outcomes as in the old system.
Over the last decade, significant changes have been implemented in the organization and financing of the mental healthcare system in the Netherlands (Nas and Van Geldrdop 2013; Westra et al. 2016). The reforms started with the introduction of regulated competition, in which service providers have to negotiate with health insurers on both costs and quality of care. The overall goal of the reforms was to realise a national healthcare system that is accessible for every citizen, is affordable, and improves the quality of care.
In the short run, it seems that the treatment setting in basic mental healthcare contributed towards the aims of the healthcare reform, i.e. lower costs with equal or better outcome. This means that for a specific population, shortening treatment duration does not come at the expense of the effectiveness of the treatment. This is in line with the outcomes presented by Cuijpers et al. (Cuijpers et al. 2013), who used a meta regression analysis to show that there was no association between the number of therapy sessions and the effect size when using psychotherapy in the treatment of adults with depression. Finding similar effectiveness in these short treatments in basic mental healthcare may be due to the prior knowledge of both therapist and patient that treatment will be of limited duration. This knowledge may influence the behaviour of the patient as well as the therapist. Several studies show that the actual number of sessions is related to the number of sessions expected by patients (Mueller and Pekarik 2000; Owen et al. 2009). Moreover, the expectation of a short treatment compared to the expectation of a long treatment is related to a quicker response (Barkham et al. 1996). For a therapist, this limitation means that on the one hand the treatment has to be focused from the very start but on the other hand the therapist must actively encourage the self management and empowerment of the patient. Focusing, i.e. minimizing distractions and changes in treatment, increases the effectiveness of treatment (Schulte and Eifert 2002). This requires therapists who are specifically trained in such a focussed method, and who are able to empower the patient to take responsibility and self direction in his treatment.
The aim of this study was to compare the costs and effects for patients treated in basic mental healthcare with that for comparable patients treated in specialized mental healthcare. For the group of patients that was eligible for basic mental healthcare, the results suggest that treatment in the basic mental healthcare approach (after the reform of the mental healthcare system) was cost-saving. Treatment in basic mental healthcare showed a large significant reduction in costs, with similar health effects. Probabilistic uncertainty analysis showed that the average estimates of costs are robust, and that the potential loss in effect is negligible.