Abstract
Objectives. To estimate the prevalence of comorbid physical and mental disorders as well as their treatment costs in the total cost of services provided on a psychiatric ward of a general hospital.
Method. On the grounds of medical records the number of patients treated for comorbid physical and mental disorders and of those receiving only psychiatric treatment over the period of 12 months (in the year 2008) was calculated in three general hospitals in Warsaw (Bielański, Wolski & Bródnowski). An increase in medical costs incurred by treatment of physical disorders in patients of the psychiatric ward at the Bielański Hospital was calculated as a percentage of the purely psychiatric treatment cost. On these grounds the increase in personal costs of treatment of patients with comorbidities was estimated. Using the person-day cost for delivery of services contracted in the year 2008 and the percentage of psychiatric patients with comorbidities treated on the ward, the amount of underestimation of the actual person-day cost of treatment on the ward was calculated as a percent of the contracted person-day cost.
Results. Between 46.9% and 53.3% of patients treated on the wards under study had a comorbid physical disease. The most frequent conditions included cardiovascular, metabolic and endocrine diseases, alimentary tract and pulmonary disorders. The average medical cost of one person-day for the patient with a comorbid physical illness was by 23.6% higher than that for the patient receiving psychiatric treatment only. The average underestimation of only medical and personal costs per one patient treated on the ward amounted to 36.98% of the person-day cost offered in the contract by the National Health Fund (NFZ).
Conclusions. Since the costs of services delivered on psychiatric wards of general hospitals are underestimated, it is necessary to change the principles of contracting such services. Approximately 47%-53% of patients treated on psychiatric wards in general hospitals suffer from comorbid physical diseases increasing the total costs of their treatment by 23.6%. The increased costs of services delivery on psychiatric wards should be accounted for in the NFZ contracts in order both to establish new psychiatric wards in general hospitals, and to maintain the already existing ones.