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

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Abstract

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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Funding

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

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Authors and Affiliations

  1. Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain

    Rodrigo Carmona MD, Enrique Baca-García MD & Miren Iza MD

  2. Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, 01241, USA

    Benjamin Lê Cook PhD, MPH

  3. Department of Psychiatry, Harvard Medical School, Boston, MA, USA

    Benjamin Lê Cook PhD, MPH & Margarita Alegría PhD

  4. Psychiatry Department, Autonoma University of Madrid, Madrid, Spain

    Enrique Baca-García MD

  5. Department of Psychiatry, University Hospital Rey Juan Carlos, Madrid, Spain

    Enrique Baca-García MD

  6. Department of Psychiatry, General Hospital of Villalba, Madrid, Spain

    Enrique Baca-García MD

  7. Department of Psychiatry, University Hospital Infanta Elena, Madrid, Spain

    Enrique Baca-García MD

  8. CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain

    Enrique Baca-García MD

  9. Universidad Católica del Maule, Curico, Chile

    Enrique Baca-García MD

  10. Behavioral Sciences Research Institute, University of Puerto Rico Medical Sciences Campus, Rio Piedras, 00935, Puerto Rico

    Ligia Chavez PhD

  11. Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA

    Kiara Alvarez PhD & Margarita Alegría PhD

Authors
  1. Rodrigo Carmona MD
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  2. Benjamin Lê Cook PhD, MPH
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  3. Enrique Baca-García MD
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  4. Ligia Chavez PhD
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  5. Kiara Alvarez PhD
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  6. Miren Iza MD
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  7. Margarita Alegría PhD
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Corresponding author

Correspondence to Margarita Alegría PhD.

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Carmona, R., Cook, B.L., Baca-García, E. et al. Comparison of Mental Health Treatment Adequacy and Costs in Public Hospitals in Boston and Madrid. J Behav Health Serv Res 46, 464–474 (2019). https://doi.org/10.1007/s11414-018-9596-9

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  • DOI: https://doi.org/10.1007/s11414-018-9596-9

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