Cost-offset analysis of mental health intervention for crime victims in the primary care setting

Abstract

Based on financial and billing records, the medical utilization behavior of 105 working adult women members of an employer-sponsored prepaid healthcare plan was examined prospectively over a five-year period. Utilization was evaluated 2.5 years pre- and 2.5 years post-crime for three groups of women: nonvictims (those women reporting no prior history of crime event), victims of noncontact crimes (theft, burglary, attempted crimes), and victims of contact crimes (assault, rape, and rape/assault). Results of interrupted time-series analysis indicated an abrupt, permanent (at least extended) impact for the crime event on use of physician services that was significant for both groups of crime victims (noncontact and contact crimes). The findings were similar across outpatient medical utilization indicators (frequency of visits and associated costs/charges). In terms of percent changes in levels of usage over time, contact crime victims increased physician visits 32-36% over baseline, noncontact crime victims increased 30-50% from baseline, and there was no change in the nonvictim comparison subjects. A second analysis was conducted to investigate the effects of mental health treatment on the use of outpatient medicine. Groups were classified into mental health users and nonusers as well as victims of crime (no crime, noncontact crime, contact crime). Results of interrupted time-series assessment on the effects of psychosocial stress by victimization on medical utilization indicated non-significant changes-over-time for victims of noncontact and contact crimes as well as nonvictim comparison subjects who utilized mental health services during the 5-year study frame. Mental health usage was defined as one or more visits to the Department of Psychiatry within the 5-year measurement time frame. A decline in outpatient utilization from preassault baseline to postassault by 12-17% was observed for victims of contact crimes who received mental health services. The results lended support the hypothesis that increased utilization followed the experience of stress by crime victimization and, that mental health had a buffering role in the moderation of increased utilization following a stressful event. The results suggested that healthcare policy should consider greater access to mental health services and that these services may be most effectively utilized when directed toward special populations of medical patients.