Variation in use and costs of primary health and social services in mental health or drinking problems.

BACKGROUND: Psychiatric inpatient hospital care was cut dramatically in Finland in recent last decades, and patients were assigned to care in the community. Consequently, the burden of care shifted from hospital districts to municipalities, which have considerable autonomy in organizing health and social services. These changes probably created locally differing service patterns in mental health care.

AIMS OF THE STUDY: We assessed the use of primary social and health care due to mental health and drinking problems and the resulting costs. We also examined differences between municipalities, and analysed factors which may be associated with the variation in use and costs of these services.

METHODS: Data were collected in five municipalities in Pirkanmaa Hospital District, Finland, using a short questionnaire containing questions on e.g. the reason for the visit, time spent during the visit, and of the client's psychosocial functioning (Global Assessment of Function Scale, GAF). The questionnaire was completed at all individual clients' visits to these services during a two-week period in December 2003, by professionals (MD's, nurses, social workers etc.) who worked in either local health or social services. Descriptive statistics and several regression techniques were used to describe and analyse factors associated with the use and costs of services.

RESULTS: During the study period, altogether 25,738 visits took place, the total number of visitors being 10,265. Of these visitors, 1,360 had mental health or drinking problems totalling to 4,471 visits. Most of these visits took place to mental health clinics or were visits made as home care. The average cost of mental health work in primary care per client was 29.8 in two weeks, ranging between municipalities from 29 to 52 . Client's poor GAF and being a recipient of home care were associated with higher costs of services. Even after controlling for visitor-related factors, use and costs of services were associated with the local service patterns.

DISCUSSION: The response rate could not be calculated for each service producer; however, we estimated that this varied between 50% and 100%. Therefore our results represent this visitor population. However, our limited data did not allow any analysis of municipality-related factors which might explain the role of service patterns in costs and use of services.

IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: A considerable proportion of total use and costs of local welfare services are due to mental health problems. The differences between municipal service patterns cause variation in total costs of care of mental disorders.

IMPLICATIONS FOR HEALTH POLICIES: Some capacity in local primary services is allocated to mental health problems, thus enabling a shift from institutional care toward community care. However, varying local patterns may cause a risk to unequal access to mental health services.

IMPLICATIONS FOR FURTHER RESEARCH: In future studies it is important to analyse the properties of local service patterns which influence appropriate use and optimal costs of care.