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Tijdschrift voor Psychiatrie 55 (2013) 9, 655 - 663

New research

Forcing patients with bipolar disorder to make a financial contribution to secondary psychiatric care may make them forsake care completely

H.M. Visser, J.W. Renes, D. Koninkx, R.W. Kupka


background In 2012 patients were required to make a personal financial contribution for secondary mental health care over and above their standard insurance fee. According to current guidelines, the majority of patients with bipolar disorder must be treated as outpatients at psychiatric clinics. It was to be expected that some patients would decide to discontinue their outpatient treatment on account of the newly imposed personal financial contribution.
aim To obtain insight into the size and characteristics of the group of patients with bipolar disorder who were thinking about giving up treatment or had already decided to give it up because of the imposition of the personal financial contribution; also to find out which factors influenced patients’ decisions and to discover how patients perceived the role of the GP as the provider of subsequent psychiatric care.
method We conducted an exploratory study by sending a survey to all outpatients receiving treatment at three clinics specialising in the treatment of bipolar disorder.
results 640 patients responded to the survey (55% response); 15% of these patients were thinking about giving up treatment or had already decided to stop their treatment. They were influenced primarily by financial considerations. Two-thirds of the respondents did not consider that the GP was as a suitable alternative to outpatient care at a clinic. Even patients with moderate to serious symptoms were considering leaving secondary care.
conclusion The obligatory financial contribution for secondary mental health care could have considerable consequences for a small number of patients with severe mood disorder who are currently treated as outpatients in secondary facilities. The increase in the compulsory ‘own risk’ insurance fee as from 2013 could have similar consequences.

keywords bipolar disorder, financial contribution, leaving care, secondary care