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How does the integration of collaborative care elements in a gatekeeping system affect the costs for mental health care in Germany?


  • Alexander Engels

    (University Medical Center Hamburg-Eppendorf)

  • Katrin Christiane Reber

    (University Medical Center Hamburg-Eppendorf)

  • Julia Luise Magaard

    (University Medical Center Hamburg-Eppendorf)

  • Martin Härter

    (University Medical Center Hamburg-Eppendorf)

  • Sabine Hawighorst-Knapstein

    (AOK Baden-Württemberg)

  • Ariane Chaudhuri

    (AOK Baden-Württemberg)

  • Christian Brettschneider

    (University Medical Center Hamburg-Eppendorf)

  • Hans-Helmut König

    (University Medical Center Hamburg-Eppendorf)


Mental disorders are widespread, debilitating and associated with high costs. In Germany, usual care (UC) for mental disorders is afflicted by poor coordination between providers and long waiting times. Recently, the primary alternative to UC—the gatekeeping-based general practitioners (GP) program—was extended by the collaborative Psychiatry–Neurology–Psychotherapy (PNP) program, which is a selective contract designed to improve mental health care and the allocation of resources. Here, we assess the effects of the GP program and the PNP program on costs for mental health care. We analyzed claims data from 2014 to 2016 of 55,472 adults with a disorder addressed by PNP to compare costs and sick leave days between PNP, the GP program and UC. The individuals were grouped and balanced via entropy balancing to adjust for potentially confounding covariates. We employed a negative binomial model to compare sick leave days and two-part models to compare sick pay, outpatient, inpatient and medication costs over a 12-month period. The PNP program significantly reduced sick pay by 164€, compared to UC, and by 177€, compared to the GP program. Consistently, sick leave days were lower in PNP. We found lower inpatient costs in PNP than in UC (−194€) and in the GP program (−177€), but no reduction in those shares of inpatient costs that accrued in psychiatric or neurological departments. Our results suggest that integrating collaborative care elements in a gatekeeping system can favourably impact costs. In contrast, we found no evidence that the widely implemented GP program reduces costs for mental health care.

Suggested Citation

  • Alexander Engels & Katrin Christiane Reber & Julia Luise Magaard & Martin Härter & Sabine Hawighorst-Knapstein & Ariane Chaudhuri & Christian Brettschneider & Hans-Helmut König, 2020. "How does the integration of collaborative care elements in a gatekeeping system affect the costs for mental health care in Germany?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(5), pages 751-761, July.
  • Handle: RePEc:spr:eujhec:v:21:y:2020:i:5:d:10.1007_s10198-020-01170-3
    DOI: 10.1007/s10198-020-01170-3

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    References listed on IDEAS

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    Blog mentions

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    1. Chris Sampson’s journal round-up for 27th July 2020
      by Chris Sampson in The Academic Health Economists' Blog on 2020-07-27 11:00:01

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    More about this item


    Cost comparison analysis; Collaborative care; Selective contract; Mental Health Care; Gatekeeping;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets


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