Comparison of Mental Health Treatment Adequacy and Costs in Public Hospitals in Boston and Madrid

  • Rodrigo Carmona
  • Benjamin Lê Cook
  • Enrique Baca-García
  • Ligia Chavez
  • Kiara Alvarez
  • Miren Iza
  • Margarita Alegría


Analyses of healthcare expenditures and adequacy are needed to identify cost-effective policies and practices that improve mental healthcare quality. Data are from 2010 to 2012 electronic health records from three hospital psychiatry departments in Madrid (n = 29,944 person-years) and three in Boston (n = 14,109 person-years). Two-part multivariate generalized linear regression and logistic regression models were estimated to identify site differences in mental healthcare expenditures and quality of care. Annual total average treatment expenditures were $4442.14 in Boston and $2277.48 in Madrid. Boston patients used inpatient services more frequently and had higher 30-day re-admission rates (23.7 vs. 8.7%) despite higher rates of minimally adequate care (49.5 vs. 34.8%). Patients in Madrid were more likely to receive psychotropic medication, had fewer inpatient stays and readmissions, and had lower expenditures, but had lower rates of minimally adequate care. Differences in insurance and healthcare system policies and mental health professional roles may explain these dissimilarities.


Funding Information

This study was supported by the National Institute on Drug Abuse Grant 5R01DA034952-02. Researchers are independent from funders.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that there are no conflicts of interest.


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Copyright information

© National Council for Behavioral Health 2018

Authors and Affiliations

  • Rodrigo Carmona
    • 1
  • Benjamin Lê Cook
    • 2
    • 3
  • Enrique Baca-García
    • 1
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
  • Ligia Chavez
    • 10
  • Kiara Alvarez
    • 11
  • Miren Iza
    • 1
  • Margarita Alegría
    • 3
    • 11
  1. 1.Fundación Jiménez DíazMadridSpain
  2. 2.Health Equity Research LabCambridge Health Alliance and Harvard Medical SchoolCambridgeUSA
  3. 3.Department of PsychiatryHarvard Medical SchoolBostonUSA
  4. 4.Psychiatry DepartmentAutonoma University of MadridMadridSpain
  5. 5.Department of PsychiatryUniversity Hospital Rey Juan CarlosMadridSpain
  6. 6.Department of PsychiatryGeneral Hospital of VillalbaMadridSpain
  7. 7.Department of PsychiatryUniversity Hospital Infanta ElenaMadridSpain
  8. 8.CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of HealthMadridSpain
  9. 9.Universidad Católica del MauleCuricoChile
  10. 10.Behavioral Sciences Research InstituteUniversity of Puerto Rico Medical Sciences CampusRio PiedrasPuerto Rico
  11. 11.Disparities Research Unit, Department of MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA

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