title: Mental health care and out-of-pocket expenditures in Europe: results from the ESEMeD project.
abstract: BACKGROUND
  Most published data on out-of-pocket spending on mental health originate from the United States, where insurance payments for mental health have traditionally been much less generous than benefits for other health care services. Given the difference in the structure of health care funding in Europe, it is clearly important to obtain similar information on out-of-pocket expenditure in different European countries.
  
  
  OBJECTIVE
  To estimate out-of-pocket costs paid by people who receive mental health care in six European countries (Belgium, France, Germany, Italy, the Netherlands, and Spain).
  
  
  METHODS
  Of the 8,796 participants in a cross-sectional survey conducted in these six European countries, 1,128 reported having consulted a professional for a mental health problem in the year preceding the interview and provided information on how many times in the past year they consulted each type of provider, and the money they and their family members had paid out-of-pocket for their mental health care. In addition to sociodemographic characteristics, information on mental health status was collected using the CIDI 3.0. Descriptive statistics on out-of-pocket expenditure and share of income across countries were generated. Two-part models were employed to identify the relationship between the different covariates, notably the types of providers consulted, and out-of-pocket expenditure.
  
  
  RESULTS
  Overall, 41.0% of those who used services for a mental health problem paid something for the care they received. This represented a minority of respondents in all countries except Belgium (87.9%) and Italy (61.7%). The financial burden of these costs relative to income was found to be low (1.2%), ranging from 0.4% in Germany to 2.3% in France. Out-of-pocket expenditure differed according to the type of providers consulted, with non-physician health professionals and medical specialists being more often associated with significant expenditure.
  
  
  CONCLUSIONS
  Although the study is limited principally by data collection from self-report, it is the first of its kind, to our knowledge, and suggests that out-of-pocket costs for mental health care in Europe are relatively low compared to the United States. However, differences between countries exist, which may be partially due to differences in coverage for specialized care.
  
  
  CONCLUSIONS
  Consultations with non-physician mental health professionals such as psychologists are expensive for patients, since they are reimbursed to a lesser extent than consultations with physicians, or not reimbursed at all. This limits their role and increases the burden on psychiatrists.
  
  
  CONCLUSIONS
  Monitoring out-of-pocket spending on mental health, preferably on the basis of administrative data when available, is essential in the current context of cost containment policy, where out-of-pocket spending may be expected to increase.
authors: MGEN Foundation for Public Health, 3 square Max Hymans, 75748 Paris Cedex 15, France. csevilla@mgen.fr
authors: Christine
authors: C
authors: Sevilla-Dedieu
authors: Viviane
authors: V
authors: Kovess-Masfety
authors: Fabien
authors: F
authors: Gilbert
authors: Gemma
authors: G
authors: Vilagut
authors: Hans-Helmut
authors: HH
authors: Koenig
authors: Ronny
authors: R
authors: Bruffaerts
authors: Josep Maria
authors: JM
authors: Haro
authors: Jordi
authors: J
authors: Alonso
mesh_terms: D000293:Adolescent; D000328:Adult; D017047:Cost Sharing / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D012959:Socioeconomic Factors; D055815:Young Adult