Out-of-pocket health expenditures in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders: findings from a study in a psychiatry outpatient clinic in Turkey

• Published in: Social Psychiatry and Psychiatric Epidemiology 2018-02, Vol.53 (2), p.151-160
• Main Authors: Islek, Duygu, Kilic, Bulent, Akdede, Berna Binnur
• Format: Article
• Language: English
• Subjects: Adult; Analysis; Anxiety; Anxiety disorders; Anxiety Disorders - economics; Bipolar disorder; Bipolar Disorder - economics; Care and treatment; Clinics; Dependent variables; Disorders; Education; Epidemiology; Equivalence; Expenditures; Family income; Female; Health; Health care expenditures; Health Expenditures - statistics & numerical data; Health insurance; Health insurance industry; Hospitalization - economics; Households; Humans; Income; Independent variables; Insurance; Insurance, Health - statistics & numerical data; Male; Medical care, Cost of; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Mental Health Services - economics; Original Paper; Patients; Psychiatry; Psychosis; Psychotic Disorders - economics; Regression analysis; Schizophrenia; Schizophrenia - economics; Turkey
• ISSN: 0933-7954; 1433-9285
• DOI: 10.1007/s00127-017-1465-y

Purpose The aim of this study is to explore the amount of OOP health expenditures and their determinants in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders in a psychiatry outpatient clinic of Turkey. Methods The study group was 191 patients who attended to the Psychiatry Outpatient Clinic in June 2014. All patients were previously diagnosed with either ‘bipolar disorder’, ‘anxiety disorder’ or ‘schizophrenia and other psychotic disorders’. The dependent variable was OOP expenditures for prescription, medical tests and examinations. Independent variables were age, gender, education, occupation, existence of social and/or private health insurance, equivalent household income and the financial resources. Student’s t test, Mann–Whitney U test, ANOVA and logistic regression methods were applied with SPSS 15.0 for analysis. Results OOP expenditures per admission were higher in patients with schizophrenia and other psychotic disorders ($8.4) than those with anxiety disorders ($4.8) ( p  = 0.02). OOP expenditures were higher in patients paying with debit ($9.8) than paying with monthly income ($6.2) ( p  = 0.04). OOP expenditures were higher in patients without social health insurance ($45.8) than others ($4.8) ( p  = 0.003). There was not a difference in OOP expenditures with respect to equivalent household income level, occupational class or education level of the patients (respectively p : 0.90, p : 0.09, p : 0.52). Conclusions Patients who were diagnosed with ‘schizophrenia and other psychotic disorders’ were disadvantaged in paying significantly higher amounts for their treatment. A substantial group of these patients compulsorily payed with debit. Considering this financial burden, diagnosis of the patient should be prioritized in health insurance coverage.