Skip to main content
SpringerLink
Log in

Costs of Mental Health Services in Czechia: Facilitating an Evidence-Based Reform of Psychiatric Care

  • Original Research Article
  • Published:
Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Background

Information about unit costs of psychiatric care is largely unavailable in Central and Eastern Europe, which poses an obstacle to economic evaluations as well as evidence-based development of the care in the region.

Objective

The objective of this study was to calculate the unit costs of inpatient and community mental health services in Czechia and to assess the current practices of data collection by mental healthcare providers.

Methods

We used bottom-up microcosting to calculate unit costs from detailed longitudinal accounts and records kept by three psychiatric hospitals and three community mental health providers.

Results

An inpatient day in a psychiatric hospital costs 1504 Czech koruna (CZK; €59), out of which 75% is consumed by hotel services and the rest by medication and therapies. The costed inpatient therapies include individual therapies provided by a psychiatrist or psychologist, consultations with a social worker, group therapies, organised cultural activities and training activities. As regards the community setting, we costed daycare social facilities, case management services, sheltered housing, supported housing, crisis help, social therapeutic workshops, individual placement and support, and self-help groups.

Conclusions

The unit costs enable assigning financial value to individual items monitored by the Czech version of the Client Service Receipt Inventory, and thus estimation of costs associated with treatment of mental health problems. The employed methodology might serve as a guideline for the providers to improve data collection and to calculate costs of services themselves, with this information likely becoming more crucial for payers in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. The hospitals record their overhead costs differently. PH1 is most accurate, assigning them to several cost centres performing services shared by the entire hospital, such as management or security. The other two hospitals instead report tens (PH2) to hundreds (PH3) of entries defined by what the money was spent on, e.g. food for employees; we logically sorted these entries, relying on categories based on PH1’s classification and adding four more: General material, Medical material, Rents, fees, taxes and Depreciation. The different accounting practices significantly limit usefulness of any direct comparison. To illustrate, while PH1 assigns depreciation of assets to the cost centre that uses these assets (e.g. management, security or particular ward), PH2 and PH3 report overall depreciation as a separate entry without distinguishing between the functions for which the assets are used. Table 2 should thus be understood as only an illustration of items that are considered overhead costs.

  2. Inpatient day without any depreciation × 100/(100 – mean depreciation share).

  3. [Inpatient day PH Petrohrad Ward1 + Inpatient day PH Opava Ward1 + (Inpatient day PH Bohnice Ward1 + Inpatient day PH Bohnice Ward2 + Inpatient day PH Bohnice Ward3 + Inpatient day PH Bohnice Ward4)/4]/3.

  4. Inpatient week = inpatient day × 7.

References

  1. Ministry of Health of the Czech Republic. Psychiatric care reform strategy. Prague: MHCR; 2013.

    Google Scholar 

  2. Beecham J, Knapp M. Costing psychiatric interventions. In: Thornicroft G, editor. Measuring mental health needs. London: Gaskell; 2001. p. 544.

    Google Scholar 

  3. Graves N, Walker D, Raine R, Hutchings A, Roberts JA. Cost data for individual patients included in clinical studies: no amount of statistical analysis can compensate for inadequate costing methods. Health Econ. 2002;11(8):735–9.

    Article  Google Scholar 

  4. Knapp M. Principles of applied cost research. In: Netten A, Beecham J, editors. Costing community care: theory and practice. Cambridge: Cambridge University Press; 1993.

    Google Scholar 

  5. Winkler P, Koeser L, Kondrátová L, Broulíková HM, Páv M, Kališová L, et al. Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: an economic analysis. Lancet Psychiatry. 2018;5(12):1023–31.

    Article  Google Scholar 

  6. Kalisova L, Pav M, Winkler P, Michalec J, Killaspy H. Quality of care in long-term care departments in mental health facilities across the Czech Republic. Eur J Public Health. 2018;28(5):885–90.

    Article  Google Scholar 

  7. Beecham J, Knapp M. Costing psychiatric interventions. In: Thornicroft G, editor. Measuring mental health needs. 2nd ed. London: Gaskell; 2001. p. 163–83.

    Google Scholar 

  8. Chisholm D, Knapp MRJ, Knudsen HC, Amaddeo F, Gaite L, van Wijngaarden B. Client Socio-Demographic and Service Receipt Inventory—European Version: development of an instrument for international research: EPSILON study 5. Br J Psychiatry. 2000;177(S39):s28–33.

    Article  Google Scholar 

  9. Winkler P, Barrett B, McCrone P, Csémy L, Janous̆ková M, Höschl C. Deinstitutionalised patients, homelessness and imprisonment: systematic review. Br J Psychiatry. 2016;208(5):421–8.

    Article  Google Scholar 

  10. Kunitoh N. From hospital to the community: the influence of deinstitutionalization on discharged long-stay psychiatric patients. Psychiatry Clin Neurosci. 2013;67(6):384–96.

    Article  Google Scholar 

  11. Winkler P, Mladá K, Krupchanka D, Agius M, Ray MK, Höschl C. Long-term hospitalizations for schizophrenia in the Czech Republic 1998–2012. Schizophr Res. 2016;175(1):180–5.

    Article  Google Scholar 

  12. Winkler P, Krupchanka D, Roberts T, Kondratova L, Machů V, Höschl C, et al. A blind spot on the global mental health map: a scoping review of 25 years’ development of mental health care for people with severe mental illnesses in central and eastern Europe. Lancet Psychiatry. 2017;4(8):634–42.

    Article  Google Scholar 

  13. Raftery J. Economics notes: costing in economic evaluation. BMJ. 2000;320(7249):1597.

    Article  CAS  Google Scholar 

  14. Bebbington A. Calculating unit costs of centre for people with AIDS/HIV. In: Netten A, Beecham J, editors. Costing community care: theory and practice. Cambridge: Cambridge University Press; 1993.

    Google Scholar 

  15. Allen C, Beecham J. Costing services: ideals and reality. In: Netten A, Beecham J, editors. Costing community care: theory and practice. Cambridge: Cambridge University Press; 1993.

    Google Scholar 

  16. Tan SS, Rutten F, Van Ineveld B, Redekop W, Hakkaart-van Roijen L. Comparing methodologies for the cost estimation of hospital services. Eur J Health Econ. 2009;10(1):39–45.

    Article  CAS  Google Scholar 

  17. Institute of Health Information and Statistics. Economic information on health care 2013. Prague: IHIS; 2014.

    Google Scholar 

  18. Beecham J, Hallam A, Knapp M, Carpenter J, Cambridge P, Forrester-Jones R, et al. Twelve years on: service use and costs for people with mental health problems who left psychiatric hospital. J Mental Health. 2004;13(4):363–77.

    Article  Google Scholar 

  19. Knapp M, Beecham J, McDaid D, Matosevic T, Smith M. The economic consequences of deinstitutionalisation of mental health services: lessons from a systematic review of European experience. Health Soc Care Commun. 2011;19(2):113–25.

    Google Scholar 

  20. Tansella M, Amaddeo F, Burti L, Lasalvia A, Ruggeri M. Evaluating a community-based mental health service focusing on severe mental illness. The Verona experience. Acta Psychiatr Scand. 2006;113(s429):90–4.

    Article  Google Scholar 

  21. Heider D, Bernert S, König H-H, Matschinger H, Hogh T, Brugha TS, et al. Direct medical mental health care costs of schizophrenia in France, Germany and the United Kingdom—findings from the European Schizophrenia Cohort (EuroSC). Eur Psychiatry. 2009;24(4):216–24.

    Article  Google Scholar 

  22. Knapp M, Chisholm D, Leese M, Amaddeo F, Tansella M, Schene A, et al. Comparing patterns and costs of schizophrenia care in five European countries: the EPSILON study. Acta Psychiatr Scand. 2002;105(1):42–54.

    Article  Google Scholar 

  23. Urdahl H, Knapp M, Edgell E, Ghandi G, Haro J, SOHO Study Group. Unit costs in international economic evaluations: resource costing of the Schizophrenia Outpatient Health Outcomes study. Acta Psychiatr Scand. 2003;107:41–7.

    Article  Google Scholar 

Download references

Acknowledgements

The authors are grateful to all participating providers: the psychiatric hospitals Bohnice, Petrohrad and Opava as well as to the community centres Fokus Mladá Boleslav, Fokus Praha and Fokus Opava. Special thanks go to our colleague Markéta Bejdová for her research on community centres.

Author information

Authors and Affiliations

  1. Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic

    Hana M. Broulíková, Petr Winkler & Lucie Kondrátová

  2. Faculty of Informatics and Statistics, University of Economics, Prague, W. Churchill Sq. 1938/4, 130 67, Prague, Czech Republic

    Hana M. Broulíková

  3. Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, David Goldberg Centre, King’s College London, De Crespigny Park, London, SE5 8AF, UK

    Petr Winkler

  4. Psychiatric Hospital Bohnice, Ústavní 91, 181 00, Prague, Czech Republic

    Marek Páv

  5. Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Ke Karlovu 11, 181 120 00, Prague, Czech Republic

    Marek Páv

Authors
  1. Hana M. Broulíková
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Petr Winkler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marek Páv
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lucie Kondrátová
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

HMB, PW, MP and LK designed the data collection and interpreted the study results. HMB analysed the data and wrote the majority of the manuscript, which is why she acts as the overall guarantor of the study. PW launched the study, led the initial negotiations with psychiatric hospitals and community mental healthcare providers, helped with data analysis, and provided expertise on the ongoing mental health reform and its need for economic evidence. MP and LK supervised interpretation of data concerning, respectively, psychiatric hospitals and community centres.

Corresponding author

Correspondence to Hana M. Broulíková.

Ethics declarations

Funding

The authors were supported by the project “Sustainability for the National Institute of Mental Health” (Grant LO1611), with financial support from the Ministry of Education, Youth and Sports of the Czech Republic, and the project “MERRPS” (grant CZ.033.X/0.0/0.0/15_124/0006067), with financial support from the Ministry of Social Affairs of the Czech Republic.

Conflict of interest

Hana M. Broulíková, Petr Winkler, Marek Páv and Lucie Kondrátová state that they have no conflicts of interest to disclose.

Disclaimer

This paper has not been presented at any conference or professional meeting. Some of the data (unit costs) have already been used for economic evaluation in the following studies: Winkler P, Koeser L, Kondrátová L, Broulíková HM, Páv M, Kališová L, et al. Cost-effectiveness of care for people with psychosis in the community and psychiatric hospitals in the Czech Republic: an economic analysis. Lancet Psychiatry. 2018;5(12):1023–31; and Winkler P, Broulíková HM, Kondrátová L, Knapp M, Arteel P, Boyer P, et al. Value of schizophrenia treatment II: decision modelling for developing early detection and early intervention services in the Czech Republic. Eur Psychiatry. 2018;53:116–22. These articles address particular mental health interventions and contain only short technical descriptions of unit costs calculation for a small number of selected services in their Appendices.

Data availability statement

The data that support the findings of this study are not publicly available as the dataset contains confidential information. The dataset is available only upon authorisation of the mental healthcare providers cooperating on the study (listed in the Acknowledgements). Further information on the data is available upon request.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Broulíková, H.M., Winkler, P., Páv, M. et al. Costs of Mental Health Services in Czechia: Facilitating an Evidence-Based Reform of Psychiatric Care. Appl Health Econ Health Policy 18, 287–298 (2020). https://doi.org/10.1007/s40258-019-00501-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40258-019-00501-7

Search

Navigation