Issues in estimating the cost of innovative mental health programs
This paper reviews problems encountered in estimating the unit cost of services provided by innovative mental health programs and illustrates methods for addressing these problems. Generally, the cost of a health care service is determined by identifying all resources used in its production and the cost of those resources. These costs are divided by appropriate workload measures to determine the cost per unit of service or per client. Issues that must be addressed include: 1) direct program costs; 2) indirect costs (including administration and capital costs); 3) program resources used to support research and othernonprogram activities; and 4) identification of “typical” workloads as the program is implemented. Application of these methods is illustrated with data from a multi-site study of intensive psychiatric community care conducted at nine Department of Veterans Affairs Medical Centers in the Northeast. A sensitivity analysis revealed that estimates of program costs vary by 59% over the entire program, and from 17%–168% at individual sites, depending on which cost estimation methods were included. The average cost of case management in this program varied considerably across sites, primarily reflecting differences in caseload size and staffing levels. Adjusting for inflation, the cost of this program falls below the cost of other published intensive community programs.
- Weisbrod BA, Test MA and Stein LI: Alternative to Mental Hospital Treatment II. Economic Benefit-Cost Analysis. Archives of General Psychiatry 37:400–405, 1980.
- Fenton FR, Tessier L, Contandriopoulis A-P, Nguyen H, and Streuning EL: A Comparative Trial of Home and Hospital Psychiatric Treatment. Financial Costs 27:177–187, 1982.
- Dickey B, Cannon NL, McGuire TG, and Gudeman JG: The Quarterway House: A Two-Year Cost Study of an Experimental Residential Program. Hospital and Community Psychiatry 37:1136–1143, 1986
- Rosenheck RA, Frisman LK and Neale MS: Estimating the Capital Component of Health Care Costs in the Public Sector (Administration and Policy in Mental Health), 21: 493–509, 1994.
- Bond GR: An Economic Analysis of Psychosocial Rehabilitation. Hospital and Community Psychiatry, 35:356–362, 1984.
- Adams ME, McCall NT, Gray DT, Orza MJ and Chalmers TC. Economic Analysis in Radomized Control Trials. Medical Care 30:231–243, 1992.
- Stein LI and Test MA: Alternative to Mental Hospital Treatment I. Conceptual model, treatment program and clinical evaluation. Archives of General Psychiatry 37:392–397, 1980.
- Anthony W, Cohen M, and Farkas M: Psychiatric Rehabilitation, Boston, University, Boston, MA, 1991.
- McGuire TG: Measuring the Economic Costs of Schizophrenia. Schizophrenia Bulletin, 17:375–388, 1991.
- US Bureau of the Census: Statistical Abstracts of the United States: 1990 (110th edition) Washington, DC, 1990.
- Hu T and Jerrell J: Cost effectiveness of alternative approaches in treating severely mentally ill in California. Schizophrenia Bulletin 17:461–468, 1991.
- Salive ME, Mayfield JA, Weissman NW: Patient Outcomes Research Teams and the Agency for Health Care Policy Research. Health Services Research. 25:697–708, 1990.
- Issues in estimating the cost of innovative mental health programs
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