[Debts, loans and unpaid bills among day patients and inpatients in psychiatric care in Berlin, Germany].
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ABSTRACT: Background
Previous studies among the general population indicated an association between mental illnesses and different forms of financial difficulties, such as indebtedness.Objective
Investigation of the financial burden and associated factors among inpatients and day clinic patients in psychiatric care.Material and methods
A total of 488 patients in psychiatric care in the catchment area of the Psychiatric University Hospital Charité at St. Hedwig Hospital participated in a cross-sectional patient survey carried out with a structured interview regarding financial burden, sociodemographic and clinical variables.Results
Of the participants 269 (55.1%) showed outstanding debts, loans or unpaid bills. Among the participants who were willing to give information about the amount of debts, the majority (47.0%) had debts between 1000 € and 9999 € and 36.3% between 10,000 € and 99,999 €. In the binary regression models, younger age and substance use disorders were factors significantly associated with outstanding debts. Of the participants 22.3% had outstanding debts >10,000 € and were depending on social welfare, so that indebtedness could be assumed.Conclusion
Financial burdens and outstanding debts among patients in psychiatric care should be inquired about and considered more intensively in practice. Suitable models of support need to be developed and evaluated.
SUBMITTER: Schreiter S
PROVIDER: S-EPMC8563525 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:This paper examines the behaviour of mental health care providers in response to marginal payment incentives induced by a discontinuous per diem reimbursement schedule with varying tariff rates over the length of stay. The analyses use administrative data on 12,627 cases treated in 82 psychiatric hospitals and wards in Germany. We investigate whether substantial reductions in marginal reimbursement per inpatient day led to strategic discharge behaviour once a certain length of stay threshold is exceeded. The data do not show gaps and bunches at the duration of treatment when marginal reimbursement decreases. Using logistic regression models, we find that providers did not react to discontinuities in marginal reimbursement by significantly reducing inpatient length of stay around the threshold. These findings are robust in terms of different model specifications and subsamples. The results indicate that if regulators aim to set incentives to decrease LOS, this might not be achieved by cuts in reimbursement over LOS.
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Project description:BackgroundMany countries worldwide have experienced reductions in provision of formal long-term care services amidst rising need for care. Provision of unpaid care, meanwhile, has grown. This includes care provided by young people. Care responsibilities can affect a young people's health, education and employment. We aimed to investigate the impacts on the employment and health of young people aged 16 to 25 of providing care, and the associated individual and public expenditure costs.MethodsWe examined employment, earnings and health impacts for individuals, and a range of economic impacts for society, focusing on young people aged 16 to 25 providing unpaid care in England. We applied regression analysis to data from three waves of the UK Household Longitudinal Study (2013/2015, 2014/2016, and 2015/2017) to compare employment and health outcomes among carers and non-carers, and two-part Generalised Linear Models to estimate costs. To address potential selection bias, we then used propensity score matching methods to explore outcomes for a matched sub-sample of young adult carers who started providing care at baseline (2014/16).ResultsYoung people aged 16 to 25 who provided care at baseline (2014/16) were less likely to be in employment, had lower earnings from paid employment, and had poorer mental and physical health at follow-up (2015/17) compared to young people of the same age who were not providing care at baseline.. There were substantial costs to the state of young adults providing care from lower tax revenue, welfare benefit payments, and health service use. In aggregate, these costs amounted to £1048 million annually in 2017.ConclusionsHigh individual impacts and costs to the state of providing unpaid care, and the potential of such impacts to compound existing inequalities, have many implications for policy and practice in the health, social care, employment and welfare benefits sectors. In particular, the findings reinforce the case for reducing the need for young people to provide unpaid care, for example through better provision of formal care services, and to provide ongoing support for those young people who do provide care. As impacts are seen in a number of domains, support needs to be multidimensional.
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