Culturally and Linguistically Diverse Patient Costing Study

1Mental Health and CALD patients

1.1Objective

405The purpose of this analysis was to identify CALD patients being treated for mental health conditions and if possible, understand the impact of cost differences between this group of patients and the rest of the sample.

406Mental health care:

• 
  Is delivered under the management of, or regularly informed by, a clinician with specialised expertise in mental health;
  
• 
  Is evidenced by an individualised formal mental health assessment and the implementation of a documented mental health plan; and
  
• 
  May include significant psychosocial components including family and carer support.
  

407We performed the analysis for Acute, ED and Outpatient encounters. Subacute encounters were not further analysed in this section, as the Psychogeriatric care type was compared to other subacute care types in section 5.3

1.1Summary of findings

408We assessed the feasibility of conducting an analysis of costs for treating CALD patients for a mental diagnosis, using the data collected from NSW, Victoria, QLD and South Australia.⁵ The results of this analysis indicate that there is insufficient data available to draw reliable conclusions about the cost of CALD patients when being treated for mental health conditions. In summary:

• 
  Acute patients: 0.17% (2,251), 0.15% (248) and 0.14% (55) of encounters per state for NSW, QLD and SA respectively related to CALD patients with a mental health diagnosis.
  
• 
  ED patients: 0.07% (1,265) and 0.02% (406) of encounters in NSW (PL and IR CALD indicators respectively) related to CALD patients with a mental health diagnosis.
  
• 
  Outpatients: 0.02% (63) of encounters in Victoria related to CALD patients with a mental health diagnosis.
  
• 
  Sub-acute: Section 5.3 of this report summarises the analysis competed of sub-acute care type of which the only care type that was consistently lower in terms of average encounter cost across all jurisdictions sampled was Psychogeriatric Care.
  

409To enable an informed opinion to identify a cost differential between CALD Mental Health patients; CALD patients; Mental Health patients; and the general population further data collection would be required to ensure sufficient comparable data was available between the patient groups.

1.1Methodology

1.1.1Criteria used to identify the key analysis group

410To identify the relevant encounters for this analysis, we utilised three patient characteristics:

• 
  CALD patients (using the same CALD criteria for each of the jurisdictions outlined at 1.1.1),
  
• 
  Non-ATSI patients (using the patient demographic information which identifies whether a patient is Indigenous),
  
• 
  Mental health encounters (refer to 1.1.1 below for the specific criteria used).
  

411There are eight combinations of CALD / non-CALD, ATSI / non-ATSI, and mental health condition / no mental health condition (outlined in the table below). This analysis focused on Group 1; CALD, non-ATSI patients with mental health encounters.

Analysis Group	CALD	ATSI	Mental Health (MH)	Key Group
Group 1	Yes	No	Yes	Yes
Group 2	Yes	No	No	No
Group 3	Yes	Yes	Yes	No
Group 4	Yes	Yes	No	No
Group 5	No	No	Yes	No
Group 6	No	No	No	No
Group 7	No	Yes	Yes	No
Group 8	No	Yes	No	No

412

1.1.1Criteria for identifying mental health encounters

413Mental health encounters were identified using clinical classifications for the products analysed.

414Acute

415Episodes classified to a DRG from the major diagnostic categories (MDC) were considered in conjunction with psychiatric care days recorded. These conditions were used to identify patients treated for mental health conditions and have been listed in the table below :

MDC Category	Psychiatric care days recorded
MDC 19 - Mental diseases and disorders	Any number of days
MDC 20 - Alcohol/drug use and alcohol/drug induced organic mental disorders	Any number of days
All other encounters not categorised as MDC 19 or MDC 20	1 or more days

416Emergency Department

Episodes with a principal diagnosis classified to a psychiatric illness major diagnostic block (MDB), identified patients treated for mental health conditions. These have been listed in the table below:

MDB Identifier	MDB Description
1D	Alcohol / drug abuse and alcohol / drug induced mental disorders
4	Psychiatric illness
5	Social problems

Outpatients

Service events classified to Tier 2 clinics where the majority of patients would be receiving mental health care were used to identify patients treated for mental health conditions. These Tier 2 clinics have been listed in the table below:

Tier 2 clinic code	Tier 2 clinic description
20.04	Developmental disabilities
20.45	Psychiatry
20.50	Psychogeriatric
20.52	Addiction Medicine
40.14	Neuropsychology
40.29	Psychology
40.30	Alcohol and Other Drugs
40.33	General Counselling
40.34	Specialist Mental Health
40.37	Psychogeriatric
40.57	Memory and Cognition