TY - JOUR
T1 - Rising co-payments and continuity of healthcare for Dutch patients with bipolar disorder
T2 - Retrospective longitudinal cohort study
AU - van der Lee, Arnold P. M.
AU - Kupka, Ralph
AU - de Haan, Lieuwe
AU - Beekman, Aartjan T. F.
PY - 2021
Y1 - 2021
N2 - Background The Netherlands has few financial barriers to access mental healthcare. However, in 2012, a sharp rise in co-payments was introduced. Aims We tested whether these increased co-payments coincided with less guideline-recommended continuous out-patient psychiatric care and more crisis interventions for patients with bipolar disorder. Method A retrospective longitudinal cohort study on a health insurance registry was performed to examine trends, and deviations from these trends, in the healthcare received by patients with bipolar disorder. Deviations of trends were tested by time-series analyses (autoregressive integrated moving average). Subsequently, the relationship between significant deviations of trends and rise in co-payments was examined. Outcome measures were the level of standard out-patient care (out-patient psychiatric care and/or medication), crisis psychiatric care and somatic care. Results The cohort comprised 3210 patients. During follow-up, the use of psychiatric care decreased and somatic care increased. The high rise in co-payments from 2012 onward coincided with decreases in standard out-patient care and increases in medication-only treatment, crisis psychiatric care and somatic care. Crisis intervention was highest when patients received only bipolar disorder medication. Patients receiving continuous standard out-patient care (62%) had less crisis intervention compared with the other patients. Conclusions Our data suggest that the rise of co-payments decreased guideline-recommended continuous out-patient psychiatric care among patients with bipolar disorder, and increased crisis psychiatric care.
AB - Background The Netherlands has few financial barriers to access mental healthcare. However, in 2012, a sharp rise in co-payments was introduced. Aims We tested whether these increased co-payments coincided with less guideline-recommended continuous out-patient psychiatric care and more crisis interventions for patients with bipolar disorder. Method A retrospective longitudinal cohort study on a health insurance registry was performed to examine trends, and deviations from these trends, in the healthcare received by patients with bipolar disorder. Deviations of trends were tested by time-series analyses (autoregressive integrated moving average). Subsequently, the relationship between significant deviations of trends and rise in co-payments was examined. Outcome measures were the level of standard out-patient care (out-patient psychiatric care and/or medication), crisis psychiatric care and somatic care. Results The cohort comprised 3210 patients. During follow-up, the use of psychiatric care decreased and somatic care increased. The high rise in co-payments from 2012 onward coincided with decreases in standard out-patient care and increases in medication-only treatment, crisis psychiatric care and somatic care. Crisis intervention was highest when patients received only bipolar disorder medication. Patients receiving continuous standard out-patient care (62%) had less crisis intervention compared with the other patients. Conclusions Our data suggest that the rise of co-payments decreased guideline-recommended continuous out-patient psychiatric care among patients with bipolar disorder, and increased crisis psychiatric care.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85127621206&origin=inward
U2 - https://doi.org/10.1192/bjo.2021.994
DO - https://doi.org/10.1192/bjo.2021.994
M3 - Article
SN - 2056-4724
VL - 7
JO - BJPsych Open
JF - BJPsych Open
IS - 5
M1 - e155
ER -