Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-20T02:06:17.726Z Has data issue: false hasContentIssue false

An economic evaluation of inpatient treatment versus day hospital care for psychiatric patients

Published online by Cambridge University Press:  13 June 2014

Jenny Hughes
Affiliation:
National University of Ireland, Galway, Ireland.
Lourde Fitzpatrick
Affiliation:
National University of Ireland, Galway, Ireland.
Elizabeth Dunne
Affiliation:
National University of Ireland, Galway, Ireland.
Mary O'Sullivan
Affiliation:
National University of Ireland, Galway, Ireland.
Margaret Cole
Affiliation:
National University of Ireland, Galway, Ireland.

Abstract

Objectives: To provide a methodology for the examination of costs and clinical outcomes in two distinct care settings for psychiatric patients inpatient and day hospitals. The major emphasis is on the relationship between costs and outcomes in the two care regimes.

Method: The study is a retrospective cost-effectiveness analysis. People living in Sector B catchment area in the Mid-Western Health Board who were admitted to inpatient care, or treated as day hospital patients, between June 1st 1994 -February 28th 1995 are eligible for inclusion in the study. Information on resource use and clinical outcome is available for 92 of these patients.

Results: The average weekly cost of care for mentally ill patients in the inpatient setting is over twice the level of the cost of care for people attending the day hospital facility. Pay costs and hotel costs are higher in the inpatient facility. Day hospital care is also more cost-effective than inpatient care, when account is taken of the relationship between cost and clinical outcomes.

Conclusion: The study supports the general literature view of the superiority of community care settings for certain categories of mentally ill people. However, the absence of randomisation in the study, incomplete data, and the retrospective nature of the analysis suggests that caution is needed in the interpretation of the results.

Type
Original Papers
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Department of Health. Shaping a Healthier Future: a strategy for effective health care in the 1990s. Dublin: Government Publications, 1994.Google Scholar
2.Dept of Health. Planning for the Future. Dublin: Stationery Office, 1984.Google Scholar
3.Knapp, M, Beecham, J. Costing Mental Health Services. Psychol Med 1990; 20: 893908.CrossRefGoogle ScholarPubMed
4.Weisbrod, BA, Test, MA, Stein, LI. Alternative to mental hospital treatment. Arch Gen Psychiatry 1980; 37: 665–75.CrossRefGoogle ScholarPubMed
5.Hoult, J, Rosen, A, Reynolds, I. Community oriented treatment compared to psychiatric hospital oriented treatment. Soc Sci Med 1984; 18: 1005–10.CrossRefGoogle Scholar
6.Knapp, Met al.Service use and costs of home-based versus hospital-based care for people with serious mental illness. Br J Psychiatry 1994; 165: 195203.CrossRefGoogle ScholarPubMed
7.Fitzpatrick, L, Dunne, EA, O'Sullivan, M, Cole, M. Alternative acute care; a study in mental health care. Limerick: Mid-Western Health Board, 1995.Google Scholar
8.Central Statistics Office. Household Budget Survey, 1994-95: preliminary results. Dublin: Government Publications, 1994.Google Scholar
9.Wolff, N, Helminiak, TW. The anatomy of cost estimates – the ‘other’ outcome. In: Hu, TW, Rupp, A eds. Advances in health economics and health services research. London: JAI Press Inc, 1993.Google Scholar
10.Blackwell, J, O'Shea, E, Moane, G, Murray, P. Care provision and cost measurement: dependent elderly people at home and in geriatric hospitals. Dublin: The Economic and Social Research Institute, 1992.Google Scholar
11.O'Donnell, O. Cost-effectiveness of community care for the chronic mentally ill. In: Freeman, H, Henderson, J eds. Evaluation of comprehensive care for the chronic mentally ill. London: Gaskell, 1991.Google Scholar
12.Evers, SMAA, Van, Wijk AS, Ament, AJHA. Economic evaluation of mental health care interventions. A Review. Health Economics 1997; 16:161–77.3.0.CO;2-I>CrossRefGoogle Scholar
13.Washburn, SMRet al.A controlled comparison of psychiatric day treatment and inpatient hospitalisation. J Con Clin Psychol 1976; 44: 665–75.CrossRefGoogle Scholar
14.Edict, JM, Gibbon, M. Brief versus standard hospitalisation: the differential costs. Am J Psychiatry 1978; 135: 707–12.Google Scholar
15.Dick, P, Cameron, L, Cohen, D, Barlow, M, Ince, A. Day and full time psychiatric treatment: a controlled comparison. Br J Psychiatry 1985; 147: 246–50.CrossRefGoogle ScholarPubMed
16.Sledge, WH, Tebes, J, Wolff, N, Helminiak, TW. Day hospital/crisis respite care versus inpatient care, part 2: service utilisation and costs. Am J Psychiatry 1996; 153(8): 1074–83.Google Scholar
17.Rubin, J. Cost measurement and cost data in mental health settings. Hosp Community Psychiatry 1982; 33: 750–4.Google ScholarPubMed
18.McCrone, P, Weich, S. Mental health care costs: paucity of measurement. Soc Psychiatry Psychiatric Epid 1996; 31(2): 70–7.CrossRefGoogle ScholarPubMed