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

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.

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Fig. 1

Notes

  1. 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. 2.

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

  3. 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. 4.

    Inpatient week = inpatient day × 7.

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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.

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Affiliations

Authors

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.

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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.

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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

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