Economic implications of shared care arrangements

Background Providing care for people with serious and enduring mental health problems has been prioritised in a number of countries. It has been recognised that good liaison between primary and secondary care services is required for care to be effective. However, little is known about the resource implications of different levels of ‘shared care’. The aim of this study is to compare service use and costs of different levels of shared care between primary and secondary care services. Method Service use data were collected at baseline and one year later for participants with severe mental illness and costs were calculated. Levels of shared care were categorised into low, medium and high tertiles. Comparisons were made between the groups using multivariate analysis to control for participant characteristics. Results Participants receiving a low level of shared care used residential care less and were less likely to have contacts with a psychiatrist or social worker than those receiving medium or high levels of shared care. Mean costs for a low level of shared care were significantly lower than for a medium level (a difference of £ 2606, 90% CI £ 452 to £ 4923), but not significantly lower than for a high level of shared care (difference of £ 1867, 90% CI – £ 287 to £ 3903). Conclusion Different levels of shared care are associated with different patterns of service use, with greater resource consumption associated with a medium level of shared care. Further work is required to investigate the causal links between integrated care and service use and costs.