Hospital healthcare utilizers with medical and psychiatric claims in the Netherlands: a nationwide study

Abstract

Background Psychiatric and medical multimorbidity is associated with low quality of life, poor functioning and excess mortality. Differences in healthcare utilization between those receiving co-occurring medical and psychiatric healthcare (HUMPCs) and those only receiving medical (HUMCs) or only psychiatric healthcare (HUPCs) may indicate differences in care accessibility, help-seeking behavior and the risk patterns of medical illness. We aimed to assess the occurrence of psychiatric diagnostic groups in HUMPCs compared to HUPCs and to compare their medical and psychiatric claims expenditures. Methods Using Dutch claims data covering psychiatric and medical hospital care in 2010–2011, healthcare utilization differences between HUMPCs and HUPCs were expressed as differences and ratios, accounting for differences in age and sex between groups. Median claims expenditures were then compared between HUMPCs and HUPCs. Results HUMPCs had 40% higher median medical cost of claims compared to HUMCs and a 10% increased number of psychiatric claims compared to HUPCs. HUMPCs were more often diagnosed with: organic disorders; behavioral syndromes associated with physiological disturbances and physical factors; mood [affective] disorders; neurotic, stress related and somatoform disorders; and disorders of adult personality and behavior. By contrast, disorders of psychological development, schizophrenia, schizotypal and delusional disorders, behavioral and emotional disorders with usual onset occurring in childhood, and mental and behavioral disorders due to psychoactive substance abuse were less often diagnosed in this group. Conclusions Both medical and psychiatric disease become more costly where both are present. For HUMPCs the costs of both medical and psychiatric claims for almost all diagnostic groups were higher than for HUPCs and HUMCs.

Defining Vision and Mission of a Medical Psychiatry Unit (MPU) for Older Adults: A Focus Group Study

“…In 2017, researchers conducted a study on the functioning of MPUs in the Netherlands. 56 The study concluded that in order to improve the quality on the unit, MPUs need to invest in: education, multidisciplinary collaboration and availability of somatic expertise on every unit. 56 The lack of permanent somatic expertise was also described in our study as a current pitfall.…”

“… 56 The study concluded that in order to improve the quality on the unit, MPUs need to invest in: education, multidisciplinary collaboration and availability of somatic expertise on every unit. 56 The lack of permanent somatic expertise was also described in our study as a current pitfall. As were other organizational barriers, such as the limitation in pharmacy opening hours, and a lack of medical equipment.…”

Making meaning of multimorbidity and severe mental illness: A viewpoint

“…As a cohort with a high healthcare cost, it is suspected that multimorbidity is a significant mediator of why this is the case for consumers with SMI (Zhang et al., 2020). Studies from the Netherlands and India have both demonstrated that the presence of simultaneous physical and mental illness is responsible for greater healthcare utilisation and costs, compared to people with mental illness alone (Pati et al., 2020; Van Schijndel et al., 2022).…”

Patients with both cancer and psychosis—to what extent do they receive specialized palliative care

“…7 Studies have shown several deficiencies in the health care system when it comes to people with both somatic and mental illnesses with worse quality of care to higher costs. 8 Socioeconomic status (SES) is a confounding factor, with schizophrenia being more prevalent in metropolitan areas and regions with lower SES. Only 6%-7% of patients with schizophrenia have regular employment in the open labor market.…”

“…A retrospective matched‐pair cohort study in Japan showed that patients with gastrointestinal cancer had more advanced disease, but a lower probability to receive less invasive treatments 7 . Studies have shown several deficiencies in the health care system when it comes to people with both somatic and mental illnesses with worse quality of care to higher costs 8 …”