title: [Forcing patients with bipolar disorder to make a financial contribution to secondary psychiatric care may make them forsake care completely].
abstract: BACKGROUND
  In 2012 patients were required to make a personal financial contribution for secondary mental health care over and above their standard insurance fee. According to current guidelines, the majority of patients with bipolar disorder must be treated as outpatients at psychiatric clinics. It was to be expected that some patients would decide to discontinue their outpatient treatment on account of the newly imposed personal financial contribution.
  
  
  OBJECTIVE
  To obtain insight into the size and characteristics of the group of patients with bipolar disorder who were thinking about giving up treatment or had already decided to give it up because of the imposition of the personal financial contribution; also to find out which factors influenced patients’ decisions and to discover how patients perceived the role of the GP as the provider of subsequent psychiatric care.
  
  
  METHODS
  We conducted an exploratory study by sending a survey to all outpatients receiving treatment at three clinics specialising in the treatment of bipolar disorder.
  
  
  RESULTS
  640 patients responded to the survey (55% response); 15% of these patients were thinking about giving up treatment or had already decided to stop their treatment. They were influenced primarily by financial considerations. Two-thirds of the respondents did not consider that the GP was as a suitable alternative to outpatient care at a clinic. Even patients with moderate to serious symptoms were considering leaving secondary care.
  
  
  CONCLUSIONS
  The obligatory financial contribution for secondary mental health care could have considerable consequences for a small number of patients with severe mood disorder who are currently treated as outpatients in secondary facilities. The increase in the compulsory & squo;own risk’ insurance fee as from 2013 could have similar consequences.
authors.affiliation: VU Medisch Centrum, en Psychiater, CGZ inGeest en Altrecht GGZ. hetty.visser@ggzingecst.nl
authors.forename: H M
authors.initials: HM
authors.lastname: Visser
authors.forename: J W
authors.initials: JW
authors.lastname: Renes
authors.forename: D
authors.initials: D
authors.lastname: Koninkx
authors.forename: R W
authors.initials: RW
authors.lastname: Kupka
mesh_terms: D000553:Ambulatory Care / Q000191:economics* / Q000379:methods; D001714:Bipolar Disorder / Q000628:therapy*; D003365:Costs and Cost Analysis; D005382:Financing, Personal; D017048:Health Care Costs; D019538:Health Care Surveys; D006801:Humans; D008605:Mental Health Services / Q000191:economics*; D017060:Patient Satisfaction; D061665:Time-to-Treatment; D019472:Universal Health Insurance