Can social firms contribute to alleviating the economic burden of psychiatric disabilities for the public healthcare system?

Abstract

In a number of countries, unemployment rates for people with psychiatric disabilities are much higher than in the general population. On the one hand, the expenses for mental health reach 3.5% of the total public health and social services budget in Québec. On the other hand, social firms (SFs) receive government subsidies. The objective was to compare public healthcare expenses for people with psychiatric disabilities who work in SFs with those associated with people with a similar condition who are looking for a job in the competitive labour market. This study followed a retrospective comparative design and considered two groups, namely: 122 employees working in SFs and 64 individuals participating in a supported employment program as job‐seekers. Two complementary datasets were used: a self‐report questionnaire and public healthcare databases. The cost analysis was performed from the perspective of the public healthcare system and included outpatient visit fees to physicians, outpatient visits to health professionals other than physicians in public healthcare centres, inpatient expenses due to hospitalisations, emergency room visits and amounts reimbursed to patients for medication. Regression analyses using generalised linear models with a gamma distribution and log link were used. Our results revealed that when controlling for sociodemographic variables (gender, age, marital status, education, physical disability), global health (EuroQol EQ‐5D‐5L), the severity of psychiatric symptoms (18‐item Brief Symptom Inventory) and self‐declared primary mental health diagnosis, annual healthcare costs paid by the public insurance system were between $1,924 and $3,912 lower for people working in SFs than for the comparison group. An explanatory hypothesis is that working in SFs could act as a substitute for medical treatments such as outpatient visits and medication use. There might be a form of compensation between supporting SFs and financing the public healthcare system, which provides valuable insights for public decision‐making.

Working Conditions in Social Firms and Health Promotion Interventions in Relation to Employees’ Health and Work-Related Outcomes—A Scoping Review

“…Significantly less emergency department or ambulatory care visits as well as reduced hospital admissions were analyzed when comparing outcomes before and during training or subsequent employment in a social enterprise [69]. Resulting impacts on annual health care costs from the perspective of the public health care system were calculated comparing social firms with individuals registered in supported employment programs [75].…”

The remarkably frequent use of EQ-5D in non-economic research

“…When EQ-5D was employed alongside cost estimates but QALYs were not calculated, it was typically used to calculate the burden in HRQoL [37][38][39], along with direct medical costs and indirect costs. In some studies, cost per QALY was not estimated, but the QALY calculations were presented anyway [40,41].…”

Economic analyses of supported employment programmes for people with mental health conditions: A systematic review

“…Only five SE studies looked at health outcomes and/or service utilisation [50,51,54,55,59]. Four reported lower healthcare costs [50,51,54,59], for example, a Norwegian RCT comparing SE plus CBT/CR to usual care had better QALY gains with lower healthcare costs after 2 years [51].…”

“…Four reported lower healthcare costs [ 50 , 51 , 54 , 59 ], for example, a Norwegian RCT comparing SE plus CBT/CR to usual care had better QALY gains with lower healthcare costs after 2 years [ 51 ]. In contrast, a Canadian analysis reported significantly lower health care costs for people working in social firms, rather than in supported employment [ 55 ]. It argued this may have been due to the therapeutic nature of social firm support.…”