background Over the last two decades, emerging knowledge about extent and impact of psychosomatic morbidity was a reason for sustained efforts in improving integrated multidisciplinary approaches, including the Medical Psychiatric Unit (mpu). Overall, fragmentation of health care, separating medical and behavioural interventions, results in poor treatment outcomes, increased medical service use and impaired work performance. Re-integration of health care is costeffective.
aim To evaluate cost-effectiveness of the mpu versus somatic wards.
methods Over the last two years approximately 300 patients with complex psychiatric and somatic morbidity entered the transmural programme of our Medical Psychiatric Centre (mpc).
results Nearly half of this population was initially referred with unexplained physical complaints. Most patients came from the consultation and liaison activities and the outpatient setting of our hospital. Only some required admission to the mpu or required day care treatment. Many were referred on to the community mental health care part of the centre. Roughly 50% suffered from a mood disorder, 30% from anxiety disorder, and 20% was diagnosed as having a somatoform disorder. Cost-analysis of our own mpu-data revealed a cost difference in favour of the mpu-setting, concerning medical diagnostic and treatment procedures, compared to medical wards. On the other hand, there was an increase in costs associated with psychiatric intervention and length of stay (los) compared to reference wards, reflecting greater psychiatric treatment
conclusion The findings suggest that the use of a multidisciplinary clinical setting at the interface of psychosomatic health care is valuable. However, failure to show cost savings in los and psychiatric interventions (outweighing medical cost benefits) indicate that mpu activities may gain in cost-effectiveness if shifted more to ambulatory psychosomatic solutions including 'transmural' activities.