title: Money matters: does the reimbursement policy for second generation antipsychotics influence the number of recorded schizophrenia patients and the burden of stigmatization?
abstract: OBJECTIVE
  In Poland, non-compliance with the reimbursement policy for second-generation antipsychotics (SGA) manifested in prescribing SGA for patients with psychotic disorders other than schizophrenia may result in serious financial penalties. In this study, we aimed at investigating whether the implementation of the reimbursement policy for SGA contributed to increasing the number of patients with a diagnosis of schizophrenia relatively to the number of patients with a diagnosis of other psychotic disorders in outpatient clinics.
  
  
  METHODS
  We analyzed data from Yearbooks of Mental Health that were published by the Institute of Psychiatry and Neurology, Warsaw, Poland in the years 1989–2009 registering the number of patients treated for various mental disorders in public facilities in Poland. Temporal trend analysis of the annual number of patients with a diagnosis of psychotic disorders, who were treated at outpatient clinics, was performed.
  
  
  RESULTS
  We found a statistically significant increase in the total number of recorded schizophrenia patients treated at outpatient clinics, as well as in the number of patients treated for the first time at outpatient clinics for schizophrenia. These changes overlap with the implementation of the reimbursement policy for SGA.
  
  
  CONCLUSIONS
  Our results suggest that the restricted reimbursement policy for SGA altered the diagnosing process in Poland. It seems that these alterations may have serious social consequences. Given that a diagnosis of schizophrenia is more stigmatizing than a diagnosis of other psychotic disorders, it might be assumed that schizophrenia over-diagnosing, possibly due to reimbursement reasons, add to the enormous burden associated with stigmatization.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kiejna
authors.forename: Blazej
authors.initials: B
authors.lastname: Misiak
authors.forename: Marta
authors.initials: M
authors.lastname: Zagdanska
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Drapala
authors.forename: Patryk
authors.initials: P
authors.lastname: Piotrowski
authors.forename: Dorota
authors.initials: D
authors.lastname: Szczesniak
authors.forename: Sylwia
authors.initials: S
authors.lastname: Chladzinska-Kiejna
authors.forename: Magdalena
authors.initials: M
authors.lastname: Cialkowska-Kuzminska
authors.forename: Dorota
authors.initials: D
authors.lastname: Frydecka
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000191:economics* / Q000627:therapeutic use; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D008297:Male; D005791:Patient Care / Q000191:economics*; D011044:Poland; D011618:Psychotic Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D012565:Schizophrenic Psychology; D013240:Stereotyping
chemical_list: D014150:Antipsychotic Agents
references.citation: Psychiatry Clin Neurosci. 2004 Oct;58(5):507-15
references.pmid: 15482582
references.citation: World Psychiatry. 2002 Feb;1(1):16-20
references.pmid: 16946807
references.citation: PLoS Med. 2005 May;2(5):e141
references.pmid: 15916472
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2013 Jun;48(6):965-73
references.pmid: 23124481
references.citation: Eur Psychiatry. 2009 Dec;24(8):513-20
references.pmid: 19699063
references.citation: BMJ. 2007 Jan 20;334(7585):108
references.pmid: 17235058
references.citation: Acta Psychiatr Scand. 2009 Nov;120(5):386-91
references.pmid: 19807720
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2013 Sep;48(9):1357-65
references.pmid: 23340770
references.citation: PLoS One. 2013;8(2):e55998
references.pmid: 23457490
references.citation: Can J Psychiatry. 2002 Nov;47(9):833-43
references.pmid: 12500753
references.citation: Schizophr Res. 2008 Sep;104(1-3):246-54
references.pmid: 18602251
references.citation: Psychiatr Pol. 2008 Nov-Dec;42(6):859-73
references.pmid: 19441664
references.citation: Schizophr Bull. 2007 Nov;33(6):1312-8
references.pmid: 17255118
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2012 Apr;47 Suppl 1:1-38
references.pmid: 22526821
references.citation: Eur Arch Psychiatry Clin Neurosci. 2000;250(6):274-85
references.pmid: 11153962
references.citation: World Psychiatry. 2006 Feb;5(1):53-5
references.pmid: 16757998
references.citation: Epidemiol Rev. 2008;30:67-76
references.pmid: 18480098
references.citation: Psychiatrie (Stuttg). 2009 Jan 1;6(1):5-9
references.pmid: 21132091
references.citation: World Psychiatry. 2013 Jun;12(2):155-64
references.pmid: 23737425
references.citation: Br J Psychiatry. 2007 Mar;190:192-3
references.pmid: 17329736
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2011 Jul;46(7):643-50
references.pmid: 20495975
references.citation: Neuro Endocrinol Lett. 2007 Feb;28 Suppl 1:35-45
references.pmid: 17262008