Comparison of service utilisation and costs of working age adults and older adults receiving treatment for psychosis and severe non-psychotic conditions in England: implications for commissioning

Abstract

Objective: Current plans in the English National Health Service are to replace block contracts for mental health providers with a single tariff for each ‘cluster’ of conditions. A single tariff will not take into account the potential additional complexity and costs inherent in caring for older people. To examine the basis for a uniform tariff, differences in service utilisation and costs between working age adults and older adults in two populous clusters (non-psychotic, psychotic) were investigated across five mental health healthcare providers in and around London. Methods: Retrospective review of records over 3 months assessing service utilisation and costs using the Client Services Receipt Inventory. Results: Records of 362 patients were reviewed, 179 older adults (90 non-psychotic, 89 psychotic) and 183 adults of working age (83 non-psychotic, 100 psychotic). Older adults in both clusters had more tests, assessments and home visits. Overall costs of care of older adults were significantly higher in the non-psychotic cluster (£5634, vs £4405 psychotic, p = 0.044). Conclusions: An appropriate age-related tariff is required for each cluster. Copyright © 2016 John Wiley & Sons, Ltd.