title: Comparison of service utilisation and costs of working age adults and older adults receiving treatment for psychosis and severe non-psychotic conditions in England: implications for commissioning.
abstract: Current plans in the English National Health Service are to replace block contracts for mental health providers with a single tariff for each 'cluster' of conditions. A single tariff will not take into account the potential additional complexity and costs inherent in caring for older people. To examine the basis for a uniform tariff, differences in service utilisation and costs between working age adults and older adults in two populous clusters (non-psychotic, psychotic) were investigated across five mental health healthcare providers in and around London.
  
  
  
  Retrospective review of records over 3 months assessing service utilisation and costs using the Client Services Receipt Inventory.
  
  
  
  Records of 362 patients were reviewed, 179 older adults (90 non-psychotic, 89 psychotic) and 183 adults of working age (83 non-psychotic, 100 psychotic). Older adults in both clusters had more tests, assessments and home visits. Overall costs of care of older adults were significantly higher in the non-psychotic cluster (£5634, vs £4405 psychotic, p = 0.044).
  
  
  
  An appropriate age-related tariff is required for each cluster. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Surrey and Borders Partnership NHS Foundation Trust, Surrey, UK.
authors.forename: Ramin
authors.initials: R
authors.lastname: Nilforooshan
authors.affiliation: Central North West London NHS Foundation Trust, London, UK.
authors.forename: Lee
authors.initials: L
authors.lastname: Benson
authors.affiliation: Surrey Health Economics Centre, School of Economics, University of Surrey, Guildford, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Gage
authors.affiliation: Department of Mathematics, University of Surrey, Guildford, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Williams
authors.affiliation: Central North West London NHS Foundation Trust, London, UK.
authors.forename: Mo
authors.initials: M
authors.lastname: Zoha
authors.affiliation: Central North West London NHS Foundation Trust, London, UK.|Department of Medicine, Imperial College, London, UK.
authors.forename: James
authors.initials: J
authors.lastname: Warner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008131:London; D008297:Male; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D011618:Psychotic Disorders / Q000191:economics* / Q000628:therapy*; D012189:Retrospective Studies; D013222:State Medicine / Q000191:economics* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: commissioning; mental health; older adults; services