Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 15, Issue 2, 2012. Pages: 53-60
Published Online: 1 June 2012

Can the Municipalities Prevent Medication of Mental Diseases?

Mickael Bech,¹ Maja Hansen,² Jørgen Lauridsen*¹, Christian Kronborg¹

¹Centre of Health Economics Research (COHERE), University of Southern Denmark, Odense, Denmark
²National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark

* Correspondence to: Jørgen Lauridsen, COHERE, University of Southern Denmark, Campusvej 55, DK-5230 Odense M, Denmark
Tel.: +45 6550 2142
Fax: +45 6550 3081
E-mail: jtl@sam.sdu.dk.

Source of Funding: None declared.

Abstract

In extension of a large Danish municipality reform, it was the intention that the municipalities should assume responsibility for a part of the expenditure connected to secondary sector health care treatment. Furthermore, the municipalities were assigned the responsibility for exerting primary preventive initiatives. The study investigates, whether the municipalities by applying these opportunities have been able to prevent medication of mental diseases. While an initial simple linear regression indicates a potential relationship between policy opportunities and medication, the relationship vanishes when adjusting for intra-municipal correlation and spatial spillover. Our results demonstrate that linkages between municipal prevention and medication for mental diseases are not only of a simple cause-response nature and indicate that targeted interventions are needed rather than broad and general public health initiatives. Future studies should involve more variables and longer times series in order to obtain proper understandings of linkages between municipal policy efforts and medication.

Background: In extension of a large municipality reform in 2007, which reduced the number of Danish municipalities from 275 to 98, it was the intention that the municipalities should assume responsibility for a part of the expenditure connected to secondary sector health care treatment. Furthermore, the municipalities were assigned the responsibility for -- and equipped with a number of opportunities for -- exerting primary preventive initiatives.

Aim of the Study: To investigate, whether the municipalities by applying these opportunities have been able to prevent medication of mental diseases. Specifically, this is resolved by analysing whether there are significant relationships between measures of municipal policy opportunities and the proportion of population medicated for mental diseases.

Methods: We apply a variety of statistical regression models. Initially, simple linear regression is applied. Next, a Seemingly Unrelated Regression approach, which accounts for intra-municipal behavioural correlation, is brought in play. Finally, this approach is extended to regressions which are adjusted for spatial spillover effects.

Results: The initial simple linear specification indicates a potential significant relationship between municipal policy opportunities and medication. However, when applying a specification which is adjusted for intra-municipal correlation, this relationship vanishes. Finally, there seem to be indications of spatial spillover effects. Thus, the relationship between municipal preventive initiatives and medication seems to be a structural, intra-municipal relationship, rather than a cause-response effect.

Implications for Health Policies: Our results show that potential linkages between municipal preventive initiatives and medication for mental diseases are not of a simple nature. Specifically, sophisticated and targeted interventions are needed rather than broad and general public health initiatives.

Implications for Further Research: Though the approach is promising, the data underlying the study is at present relatively weak. Future studies should involve more variables as well as longer times series in order to obtain proper understandings of the potential linkages between municipal policy efforts and medication.

Received 23 May 2011; accepted 7 May 2012