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Biography
Rowena Jacobs is Deputy Director and Professor of Health Economics in the Centre for Health Economics at the University of York. Rowena leads research on the economics of mental health and mental health care. Her research interests include incentives, performance measurement and funding of mental health services, the interplay between physical and mental health and the economic impact of mental health problems. She has expertise in the linkage and use of large and complex datasets to inform mental health policy. She has published widely and acted as an adviser to various UK government and other agencies, as well as the World Bank, WHO and OECD, and her research has had significant impact on policy.
Abstract
Providing high quality mental healthcare at a reasonable cost is a key policy priority in many countries. There is currently a significant evidence gap in understanding the relationship between cost and quality in mental healthcare.
We undertook a systematic review to examine this relationship, as well as the strengths/limitations of the methodology used to estimate the marginal cost of mental health care quality, where this was done. We then sought to estimate the marginal cost of quality in mental healthcare services in England for adults, for a range of quality indicators (both at the individual and at the mental health provider level), including waiting times, readmissions, continuity of care, clinician reported outcome measures and mortality. We calculate quality indicators using data from the Mental Health Service Dataset (MHSDS) for the period 2016/17-2021/22 and cost all activity in the MHSDS using National Cost Collection and Patient Level Information Costing Systems (PLICS) unit costs.
Our systematic review finds only 6 studies (of moderate to poor quality based on risk of bias) suggesting a large evidence gap. Our preliminary empirical results are heterogenous depending on the quality indicator used but find predominantly negative marginal costs, suggesting that quality improvement efforts amongst mental healthcare providers might not necessarily be more costly. Policymakers will however need to account for the nuances in results for different measures of quality.
