The journal of mental health policy and economics
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J Ment Health Policy Econ · Mar 2009
Randomized Controlled TrialCost-effectiveness analysis of integrated care for people with HIV, chronic mental illness and substance abuse disorders.
Triply diagnosed patients, who live with HIV and diagnosed mental health and substance abuse disorders, account for at least 13% of all HIV patients. This vulnerable population has substantial gaps in their care, attributable in part to the need for treatment for three illnesses from three types of providers. ⋯ Future trials with interventions with lower baseline levels of integration, longer duration and larger sample sizes may show improvement or slow the decline in quality of life. Future researchers should collect comprehensive cost data, because significant decreases in the cost of hospital care did not necessarily lead to significant decreases in the total cost of health services.
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Little is known about racial and ethnic disparities in health care utilization, expenditures and drug choice in the antidepressant market. ⋯ Reducing differences in observable characteristics such as health insurance and education will mitigate racial and ethnic disparities in expenditures on antidepressant drug use and in the types of antidepressant used (e.g., generics vs. brands; new vs old). But these factors will have less influence in reducing racial and ethnic disparities in overall antidepressant drug utilization. To limit differences in overall antidepressant drug use, policymakers must take into account cultural factors and other sources of heterogeneity.
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J Ment Health Policy Econ · Dec 2008
Insurance coverage and the treatment of mental illness: effect on medication and provider use.
Canada's public health insurance system fully covers medically necessary hospital and physician services, but does not cover community-based non-physician mental health provider services or prescription drugs. Almost 2/3 of Canadians have private supplemental insurance for extended health benefits, typically through their employer, so its distribution is skewed to higher-income, employed Canadians, and typically features substantial cost-sharing and coverage limits. A recent national survey suggests only one-third of Canadians with selected mental disorders talked to a health professional during the previous 12 months and only a minority (19.3%) receive drug treatment. Financial barriers to care constitute a potentially important contributor to this under-use of mental health treatments. ⋯ Future research should incorporate insurance measures which capture details of coverage among all survey respondents. Linking survey to utilization data will help to overcome issues of recall bias.
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J Ment Health Policy Econ · Sep 2008
Cost-effectiveness of group psychotherapy for depression in Uganda.
Low and middle-income countries are increasingly acknowledging the potential health and economic benefits associated with treatment of depression. To aid countries in making resource-allocation decisions, there is a need for cost-effectiveness analysis of treatments for depression in developing countries. Although there are a limited number of studies from developing countries that report data on treatment efficacy and costs, these data can be leveraged to tailor mathematical models that are used to evaluate the cost-effectiveness of depression treatments in specific settings. ⋯ There are a limited number of clinical studies evaluating efficacy and costs of treatments for depression in developing countries. Research on depression in such settings can further assist in providing accurate and country-contextualized estimates of cost-effectiveness.
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J Ment Health Policy Econ · Jun 2008
Caring for children with mental disorders: do state parity laws increase access to treatment?
High prevalence rates of mental health disorders in childhood have garnered increased public attention in recent years. Yet, among children diagnosed with serious mental health problems, a majority receive no treatment. Improving access to mental health services for children with behavioral and emotional disorders constitutes an important policy concern. ⋯ Since other research has shown that state parity laws are helpful in reducing the family financial burden of caring for a mentally ill child and do not drive up total health care costs, these policies serve a vital function. However, given persistent access problems in the child population, research aimed at increasing rates of mental health services use is needed. In addition, future research on parity laws should consider whether, conditional on having a visit, children in parity states are likely to have more visits compared with other children.