gms | German Medical Science

Mental and neurological disorders are widespread, debilitating and associated with high direct and indirect costs. Usual care for patients with such disorders in Gemany is considered to be poor in coordination and cooperation between providers. Since 2013, the AOK Baden-Würtemberg gradually extended its general practitioners (GP) program (“Hausarztvertrag”) with selective contracts that change regulations in the outpatient sector. One of these contracts, the PNP program (“Facharztvertrag”), aims to improve treatment for acute and chronic patients in the fields of psychiatry, neurology and psychotherapy by promoting collaborative care networks and evidence-based treatment. Studies from the United States suggest that collaborative care models may favorably influence cost-effectiveness, but the evidence for similar models in Germany is limited. The purpose of this study was to compare costs between the collaborative PNP program, the GP program and usual care from the perpective of the health insurance. Additionally, sick leave days were analyzed.

We used claims data from 2014-2016 of 55,472 adults with an index sick leave in 2015 due to a disorder addressed by PNP (i.e. affective, anxiety, somatoform, adjustment, alcohol use disorder, schizophrenia, multiple sclerosis). The individuals were grouped according to the program enrolled in the quarterly period of their index sick leave diagnosis as either usual care, GP or PNP patients. We applied entropy balancing to balance the groups regarding potentially confounding covariates. We employed two-part generalized linear models to compare groups with respect to outpatient, inpatient and medication costs as well as sick pay by the AOK during 12 months after the index sick leave. In addition, we compared the number of sick leave days using a censored negative binomial model.

The PNP program significantly (p < .05) reduced average sick pay by 164€, compared to usual care, and by 177€, compared to GP. Consistently, in PNP the number of sick leave days was 3.84 days (p < .05) lower than in usual care and 3.99 days (p < .05) lower than in GP. We found significantly (p < .05) lower inpatient costs in PNP than in usual care (-194€) and in the GP program (-177€). However, we did not find a significant reduction in psychiatric or neurological inpatient costs.

Our results indicate that the PNP program reduces costs from the health insurance perspective as well as sick leave days. However, the observed reduction of inpatient costs in the PNP group was likely due to other regulations, as the share of the specific inpatient costs due to psychiatric/neurological disorders was not reduced. Future research on subgroups, the quality of care and the underlying mechanisms are needed to recommend the implementation of similar programs.