[For a more rational funding system of mental health services. Analyses of costs for services supplied by community mental health services during a 7-year period].
OBJECTIVE
In the last years, in Italy as well as in many other developed countries, there has been a growing interest for health economics by researchers. As for as the psychiatric care is concerned, more recently, many research's groups have pointed their attention on new possible funding systems for mental health services and on their effects on services' functioning. The aim of this study is to define a new list of services' costs based on services actually delivered by a Community Mental Health Service (CMHS).


METHODS
All psychiatric contacts recorded by the South-Verona Psychiatric Case Register during a 7-year period (1992-1998) have been included in the study (125,623 contacts made by 2,819 patients). Contacts were grouped into 19 type of services. The cost function methodology was used to describe, also reporting elasticity values, costs' behaviour in the South-Verona CMHS. The cost of each service includes expenses for professionals involved (directly or indirectly) in the contacts with the patients and capital costs.


RESULTS
For each service were reported a) the cost of the service as it is actually supplied in our CMHS, b) the cost per minute, c) an estimate of the cost of service delivered with standard modalities (duration equal to the mode value registered; staff composition take into account either the actual functioning of the CMHS either indication about a good clinical practice) and, finally, d) cost of the eight services included into the reimbursement system currently in use in Italy.


CONCLUSIONS
Our results showed that services' definition used in this study allow to describe different types of psychiatric care supplied from the South-Verona CMHS. The national list currently adopted for the reimbursement in Italy should allowed to describe only 28% of the registered psychiatric contacts (35,230 vs. 125,632). The urgent need for a new list of psychiatric services, accepted at a national level, was confirmed. Cost values obtained clearly show that the funding system currently used underestimates the true costs of care delivered by the CMHS. The cost function makes available a tool to test a prospective per-capita funding system as provided in the Act No. 229 of the Italian Government.
De Agostini
P
P
Dipartimento di Medicina e Sanità Pubblica, Sezione di Psichiatria, Università di Verona.
Bonizzato
P
P
Amaddeo
F
F
Bisoffi
G
G
Perali
F
F
Tansella
M
M
D005380:Financing, Government; D017048:Health Care Costs / Q000145:classification / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D007558:Italy / Q000453:epidemiology; D001523:Mental Disorders / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics* / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling / Q000191:economics
Per un più razionale sistema di finanziamento dei Dipartimenti di Salute Mentale. Analisi dei costi delle prestazioni erogate da un Servizio Psichiatrico Territoriale in un periodo di 7 anni.