The burden of mental illness is
substantial, accounting for between 3 and 16% of total expenditure on health across OECD
countries. Severe disorders such as schizophrenia and bipolar disorder are among the top
ten causes of years lost due to disability worldwide (WHO, 2008b).
Mental health care has become a policy
priority in many OECD countries, coinciding with dramatic changes in the delivery of
mental health services. Starting in the 1970s with de-institutionalisation and the
development of modern psychiatric drugs, care has shifted from large psychiatric hospitals
towards community-based integrated care involving a multidisciplinary team. Preventive and
rehabilitative care and social integration have also been emphasised more than previously.
Paradoxically, these shifts have made it harder to track mental health care at the
population level, as few countries have a health information infrastructure suitable for
following patients across a variety of delivery settings.
Patients with severe mental disorders
still receive specialised care at hospitals but if appropriate and co-ordinated follow-up
is provided after discharges, patients are not usually re-admitted to hospital within
30 days. A high rate of unplanned re-admissions is therefore an indicator of the quality
of several dimensions of the mental health system. As part of monitoring quality of mental
health care, unplanned 30 day hospital re-admission rates are used in organisations in
different countries such as the Canadian Institute for Health Information, the Care
Quality Commission in the United Kingdom and the National Mental Health Performance
Monitoring System in the United States.
Re-admission rates for schizophrenia
vary a lot across countries, with Nordic countries and Poland at the higher end, and the
Slovak Republic and the United Kingdom at the lower end (Figure 5.7.1). Re-admission rates for bipolar disorders are also highest in
Poland and in Nordic countries (Figure 5.7.2). Most countries have similar
rates for men and women for both mental disorders.
Mental health care systems have been
developing new organisational and delivery models over the past few decades. Some
countries, such as Italy, Norway and the United Kingdom, use community-based
"crisis teams" to stabilise patients on an outpatient
basis, while Canada and the United States also emphasise community mental health care
delivery. Other countries, such as Denmark and Finland, use interval care protocols to
place unstable patients in hospital for short periods. Countries such as Denmark are also
proactive in identifying patients in need of care through outreach teams following
discharges, possibly leading to high re-admissions. A further development is a more
patient-centred approach in countries such as Canada and the United Kingdom, involving
patients in care and service plan development. These developments may also have some
implications on re-admission rates and make it more complex to identify those
re-admissions that are truly unplanned.
Unplanned re-admission is only one
measure of the quality and performance of mental health care systems, and further
indicators in domains such as treatment, care continuity, co-ordination and outcomes are
needed for a better and more complete understanding of the performance of mental health
care systems across countries.
Definition and comparability
Few administrative databases can
distinguish between unplanned and planned re-admissions. Therefore, the indicator is
defined as the number of re-admissions per 100 patients with a diagnosis of
schizophrenia or bipolar disorder. The denominator is comprised of all patients with
at least one admission during the year for the condition as principal diagnosis or as
one of the first two listed secondary diagnosis. The numerator is re-admissions for
any mental disorder to the same hospital within 30 days of discharge but excludes
same-day admissions (less than 24 hours). The data have been age-sex standardised
based on the 2005 OECD population structure, to remove the effect of different
population structures across countries.
The absence of unique patient
identifiers in many countries does not allow the tracking of patients across
hospitals. Rates are therefore biased downwards as re-admissions to a different
hospital cannot be observed. However, the 11 countries which were able to estimate
re-admission rates to the same or other hospitals, show that rates based on the two
different specifications were closely correlated and the ranking of countries was
similar (except for the Czech Republic), suggesting that re-admissions to the same
hospital can be used as a valid approximation.
ICD-code specifications of
hospital re-admissions for bipolar disorder have changed since the last data
collection, so a direct comparison with previously published data is not possible.
Information on data for Israel:
|Indicator in PDF
|5.7.1 Schizophrenia re-admissions to the same hospital, 2009
(or nearest year)
|5.7.2 Bipolar disorder re-admissions to the same hospital,
2009 (or nearest year)