Differences in Healthcare Costs in Youths with Conduct Disorders in Rural Vs. Urban Regions: an Analysis of German Health Insurance Data

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2018 Sep 16

PMID 30217151

Citations 3

Authors

Heike Gerhardt

Monika Heinzel-Gutenbrunner

Christian J Bachmann

Affiliations

Soon will be listed here.

Abstract

Background: For children and adolescents with mental health problems, there is a lack of data as to whether the type of residential area (urban vs. rural) influences healthcare costs for affected individuals. The aim of this study was therefore to explore potential urban vs. rural healthcare cost differences in children and adolescents with conduct disorder (CD), one of the most frequent and cost-intensive child and adolescent psychiatric disorders. Additionally, we aimed to compare healthcare costs of youths with CD, and of youths without this diagnosis.

Methods: We analysed data from a German health insurance company, extracting all youths with a CD diagnosis in 2011 (CD group; N = 6337), and an age- and sex-matched group without this diagnosis (control group). For both groups, annual costs per person for outpatient and inpatient healthcare were aggregated, stratified by area of residence (urban vs. rural).

Results: While mean annual overall costs in the CD group did not differ significantly between urban and rural areas of residence (2785 EUR vs. 3557 EUR, p = 0.253), inpatient treatment costs were significantly higher in rural areas (2166 EUR (60.9% of overall costs) vs. 1199 EUR (43.1% of overall costs), p < 0.0005). For outpatient healthcare costs, the reverse effect was found, with significantly higher costs in individuals from urban areas of residence (901 EUR (32.3% of overall costs) vs. 581 EUR (16.3% of overall costs), p < 0.0005). In the control group, no significant rural vs. urban difference was found for either overall health costs, inpatient or outpatient costs. Mean overall costs in the CD group were four times higher than in the control group (3162 (±5934) EUR vs. 795 (±4425) EUR).

Conclusions: This study is the first to demonstrate urban vs. rural differences in healthcare costs among youths with CD. The higher costs of inpatient treatment in rural regions may indicate a need for alternative forms of service provision and delivery in rural settings.

Citing Articles

Recognition and management of children and adolescents with conduct disorder: a real-world data study from four western countries.

Bachmann C, Scholle O, Bliddal M, dosReis S, Odsbu I, Skurtveit S Child Adolesc Psychiatry Ment Health. 2024; 18(1):18.

PMID: 38281951 PMC: 10823694. DOI: 10.1186/s13034-024-00710-6.

Secure attachment predicts lower societal cost amongst severely antisocial adolescents.

Bachmann C, Humayun S, Stevens M, OConnor T, Scott S Child Adolesc Psychiatry Ment Health. 2023; 17(1):56.

PMID: 37161491 PMC: 10170786. DOI: 10.1186/s13034-023-00598-8.

[Maintaining a comprehensive provision of inpatient child and adolescent mental health services in the years to come-a German perspective].

Bachmann C, Plener P, Mechels M, Lempp T Neuropsychiatr. 2023; 37(1):39-46.

PMID: 36717530 PMC: 9886204. DOI: 10.1007/s40211-023-00458-z.

References

Sampaio F, Barendregt J, Feldman I, Lee Y, Sawyer M, Dadds M . Population cost-effectiveness of the Triple P parenting programme for the treatment of conduct disorder: an economic modelling study. Eur Child Adolesc Psychiatry. 2017; 27(7):933-944. PMC: 6013530. DOI: 10.1007/s00787-017-1100-1. View

Nietert P, French M, Kirchner J, Han X, Booth B . Health services utilization and cost for at-risk drinkers: rural and urban comparisons. J Stud Alcohol. 2004; 65(3):353-62. DOI: 10.15288/jsa.2004.65.353. View

Bramesfeld A, Grobe T, Schwartz F . Who is treated, and how, for depression? An analysis of statutory health insurance data in Germany. Soc Psychiatry Psychiatr Epidemiol. 2007; 42(9):740-6. DOI: 10.1007/s00127-007-0225-9. View

Shivram R, Bankart J, Meltzer H, Ford T, Vostanis P, Goodman R . Service utilization by children with conduct disorders: findings from the 2004 Great Britain child mental health survey. Eur Child Adolesc Psychiatry. 2009; 18(9):555-63. DOI: 10.1007/s00787-009-0012-0. View

Tiainen A, Edman G, Flyckt L, Tomson G, Rehnberg C . Regional variations and determinants of direct psychiatric costs in Sweden. Scand J Public Health. 2008; 36(5):483-92. DOI: 10.1177/1403494808089065. View

Erskine H, Norman R, Ferrari A, Chan G, Copeland W, Whiteford H . Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry. 2016; 55(10):841-50. DOI: 10.1016/j.jaac.2016.06.016. View

Presnall N, Webster-Stratton C, Constantino J . Parent training: equivalent improvement in externalizing behavior for children with and without familial risk. J Am Acad Child Adolesc Psychiatry. 2014; 53(8):879-87, 887.e1-2. PMC: 4492282. DOI: 10.1016/j.jaac.2014.04.024. View

Bonin E, Stevens M, Beecham J, Byford S, Parsonage M . Costs and longer-term savings of parenting programmes for the prevention of persistent conduct disorder: a modelling study. BMC Public Health. 2011; 11:803. PMC: 3209459. DOI: 10.1186/1471-2458-11-803. View

Reid G, Stewart M, Vingilis E, Dozois D, Wetmore S, Jordan J . Randomized trial of distance-based treatment for young children with discipline problems seen in primary health care. Fam Pract. 2012; 30(1):14-24. PMC: 3552315. DOI: 10.1093/fampra/cms051. View

10.

Knapp M, McCrone P, Fombonne E, Beecham J, Wostear G . The Maudsley long-term follow-up of child and adolescent depression: 3. Impact of comorbid conduct disorder on service use and costs in adulthood. Br J Psychiatry. 2002; 180:19-23. DOI: 10.1192/bjp.180.1.19. View

11.

Mandell D, Novak M, Zubritsky C . Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics. 2005; 116(6):1480-6. PMC: 2861294. DOI: 10.1542/peds.2005-0185. View

12.

Mehring M, Donnachie E, Schneider A, Tauscher M, Gerlach R, Storr C . Impact of regional socioeconomic variation on coordination and cost of ambulatory care: investigation of claims data from Bavaria, Germany. BMJ Open. 2017; 7(10):e016218. PMC: 5665322. DOI: 10.1136/bmjopen-2017-016218. View

13.

Henggeler S, Rowland M, Randall J, Ward D, Pickrel S, Cunningham P . Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: clinical outcomes. J Am Acad Child Adolesc Psychiatry. 1999; 38(11):1331-9. DOI: 10.1097/00004583-199911000-00006. View

14.

Mendenhall A, Demeter C, Findling R, Frazier T, Fristad M, Youngstrom E . Mental health service use by children with serious emotional and behavioral disturbance: results from the LAMS study. Psychiatr Serv. 2011; 62(6):650-8. PMC: 3243362. DOI: 10.1176/ps.62.6.pss6206_0650. View

15.

Cummings J, Case B, Ji X, Marcus S . Availability of Youth Services in U.S. Mental Health Treatment Facilities. Adm Policy Ment Health. 2015; 43(5):717-727. PMC: 4833684. DOI: 10.1007/s10488-015-0685-2. View

16.

Bachmann M, Bachmann C, John K, Heinzel-Gutenbrunner M, Remschmidt H, Mattejat F . The effectiveness of child and adolescent psychiatric treatments in a naturalistic outpatient setting. World Psychiatry. 2010; 9(2):111-7. PMC: 2911091. DOI: 10.1002/j.2051-5545.2010.tb00288.x. View

17.

Vostanis P, Meltzer H, Goodman R, Ford T . Service utilisation by children with conduct disorders--findings from the GB National Study. Eur Child Adolesc Psychiatry. 2003; 12(5):231-8. DOI: 10.1007/s00787-003-0330-6. View

18.

Butler S, Baruch G, Hickey N, Fonagy P . A randomized controlled trial of multisystemic therapy and a statutory therapeutic intervention for young offenders. J Am Acad Child Adolesc Psychiatry. 2011; 50(12):1220-35.e2. DOI: 10.1016/j.jaac.2011.09.017. View

19.

Ziller E, Anderson N, Coburn A . Access to rural mental health services: service use and out-of-pocket costs. J Rural Health. 2010; 26(3):214-24. DOI: 10.1111/j.1748-0361.2010.00291.x. View

20.

Hope T, Bierman K . Patterns of Home and School Behavior Problems in Rural and Urban Settings. J Sch Psychol. 2009; 36(1):45-58. PMC: 2761692. DOI: 10.1016/s0022-4405(97)00049-6. View