Measuring costs of community mental health care in Italy: A prevalence-based study.

BACKGROUND: Information on individual mental healthcare costs and utilization patterns in Italy is scant. We analysed the use and the annual costs of community mental health services (MHS) in an Italian local health authority (LHA). Our aims are to compare the characteristics of patients in the top decile of costs with those of the remaining 90%, and to investigate the demographic and clinical determinants of costs. METHODS: This retrospective study is based on administrative data of adult patients with at least one contact with MHS in 2013. Costs of services were estimated using a microcosting method. We defined as high cost (HC) those patients whose community mental health services costs place them in the top decile of the cost distribution. The predictors of costs were investigated using multiple linear regression. RESULTS: The overall costs borne for 7601 patients were 17 million €, with HC accounting for 87% of costs and 73% of services. Compared with the rest of the patients, HC were younger, more likely to be male, to have a diagnosis of psychosis, and longer and more intensive MHS utilization. In multiple linear regression, younger age, longer duration of contact with MHS, psychosis, bipolar disorder, personality disorder, depression, dementia and Italian citizenship accounted for 20.7% of cost variance. CONCLUSION: Direct mental health costs are concentrated among a small fraction of patients who receive intensive socio-rehabilitation in community services. One limitation includes the unavailability of hospital costs. Our methodology is replicable and useful for national and cross-national benchmarking.

Behavior of block-polyampholytes near a charged surface.

The behavior of polyampholytes near a charged planar surface is studied by means of Monte Carlo simulations. The investigated polyampholytes are overall electrically neutral and made up of oppositely charged units (called blocks) that are highly charged and of the the same length. The influence of block length and substrate's surface-charge-density on the adsorption behavior is addressed. A detailed structural study, including local monomer concentration, monomer mean height, and transversal chain size, is provided. It is demonstrated that adsorption is favored for long enough blocks and/or high enough Coulomb interface-ion couplings. By explicitly measuring the chain size in the bulk, it is shown that the charged interface induces either a swelling or a shrinkage of the transversal dimension of the chain depending, in a non trivial manner, on the block length.