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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 14, Issue 2, 2011. Pages: 95-105
Published Online: 30 June 2011

Copyright © 2011 ICMPE.


 

Mental Health Care and Out-of-Pocket Expenditures in Europe: Results from the ESEMeD Project

Christine Sevilla-Dedieu,1* Viviane Kovess-Masféty,2 Fabien Gilbert,3 Gemma Vilagut,4 Hans-Helmut König,5 Ronny Bruffaerts,6 Josep Maria Haro,7 Jordi Alonso8

1 Ph.D., MGEN Foundation for Public Health, Paris, France
2M.D., Ph.D., EA 4069, University of Paris Descartes; Department of Epidemiology, École des Hautes Études en Santé Publique (EHESP), Paris, France
3M.Sc., MGEN Foundation for Public Health, Paris, France
4B.Sc., Health Services Research Unit, IMIM (Hospital del Mar Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
5M.D., M.P.H., Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
6Ph.D., Department of Neurosciences and Psychiatry, University Hospital Gasthuisberg, Leuven, Belgium
7M.D., Ph.D., Serveis de Salut Mental, Sant Joan de Déu, Sant Boi de Llobregat, Spain
8M.D., M.P.H., Ph.D., Health Services Research Unit, IMIM (Hospital del Mar Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain

* Correspondence to: Christine Sevilla-Dedieu, MGEN Foundation for Public Health, 3 square Max Hymans, 75748 Paris Cedex 15, France.
Tel.: +33-1-4047 2420
Fax: +33-1-4047 2191
E-mail: csevilla@mgen.fr

Source of Funding: The ESEMeD project (http://www.epremed.org) was supported by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, and other local agencies and by an unrestricted educational grant from GlaxoSmithKline.  ESEMeD is carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the WMH staff for assistance with instrumentation, fieldwork, and data analysis. These activities were supported by the United States National Institute of Mental Health (R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, the Eli Lilly & Company Foundation, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, Bristol-Myers Squibb, and Shire.

Abstract

This study explores the out-of-pocket costs paid by people who receive mental health care in Europe. Using information collected from 1,128 individuals across six countries, this study shows that 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. 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. 

 

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.

Aim of the Study: 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.

Discussion and Limitations: 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.

Implications for Health Policies: 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.

Implications for Further Research: 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.


Received 12 February 2009; accepted 23 May 2011

Copyright 2011 ICMPE