[Proposal for a new funding system for mental health departments. Results from an evaluative multicentre Italian study (I-psycost)].
OBJECTIVE
To obtain a new, well-balanced mental health funding system, through the creation of (i) a list of psychiatric interventions provided by Italian Community-based Psychiatric Services (CPS), and associated costs; (ii) a new prospective funding system for patients with a high use of resources, based on packages of care.


METHODS
Five Italian Community-based Psychiatric Services collected data from 1250 patients during October 2002. Socio-demographical and clinical characteristics and GAF scores were collected at baseline. All psychiatric contacts during the following six months were registered and categorised into 24 service contact types. Using elasticity equation and contact characteristics, we estimate the costs of care. Cluster analysis techniques identified packages of care. Logistic regression defined predictive variables of high use patients. Multinomial Logistic Model assigned each patient to a package of care.


RESULTS
The sample's socio-demographic characteristics are similar, but variations exist between the different CPS. Patients were then divided into two groups, and the group with the highest use of resources was divided into three smaller groups, based on number and type of services provided.


CONCLUSIONS
Our findings show how is possible to develop a cost predictive model to assign patients with a high use of resources to a group that can provide the right level of care. For these patients it might be possible to apply a prospective per-capita funding system based on packages of care.
Grigoletti
Laura
L
Dipartimento di Medicina e Sanità Publica, Sezione di Psichiatria e Psicologia Clinica, Universiti di Verona, Verona, Italy. laura.grigoletti@medicina.univr.it
Amaddeo
Francesco
F
Grassi
Aldrigo
A
Boldrini
Massimo
M
Chiappelli
Marco
M
Percudani
Mauro
M
Catapano
Francesco
F
Fiorillo
Andrea
A
Bartoli
Luca
L
Bacigalupi
Maurizio
M
Albanese
Paolo
P
Simonetti
Simona
S
Perali
Federico
F
De Agostini
Paola
P
Tansella
Michele
M
D002202:Capital Financing; D003164:Competitive Bidding; D006801:Humans; D007558:Italy / Q000453:epidemiology; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000191:economics*