Comparison of Mental Health Treatment Adequacy and Costs in Public Hospitals in Boston and Madrid
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.
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Conflict of Interest
The authors declare that there are no conflicts of interest.
- 25.111th Congress. Compilation of Patient Protection and Affordable Care Act: 42 U.S.C.. U.S. Department of Health and Human Services. Available online at https://www.hhs.gov/sites/default/files/ppacacon.pdf. Accessed on August 24, 2017.
- 26.Rubin DB. Multiple Imputation of Nonresponse in Surveys. New York, NY: Wiley, 2004.Google Scholar
- 33.Gosden T, Forland F, Kristiansen I, et al. Capitation, Salary, Fee-for-Service and Mixed Systems of Payment: Effects on the Behaviour of Primary Care Physicians. Cochrane Database of Systematic Reviews. 2000; Art. No.: CD002215.Google Scholar