In the Schizophrenia disease patients suffer from brain disorder. In this disease, the patients also suffer from delusions, hallucinations, disorder for thought and movement (Hamann, et al, 2007). According to the survey report of National Hospital Ambulatory Medical Care, in the time duration of 2009 to 2011 about 382,000 patients of the emergency department of the hospitals are suffering from the disease of Schizophrenia (Hamann, et al, 2007). The survey report also states that men are greatly affected by the disease as compared to the women. The researchers also include the mental homes, nursing homes, psychiatric hospitals for conducting their survey work (Hamann, et al, 2007). For getting effective idea about the disease Schizophrenia, and for analysis of the cost of the treatment of the disease, the researchers conducted a study. This disease is classified as the serious health problems. The study is based on the CEE or Central Eastern Europe.

Background

A serious health issue among the people is Schizophrenia. This study will be helpful for the researchers to get suitable idea about the total costs of the research work (Olivares, et al, 2009). The researchers conducted their research work in Central and Eastern Europe or CEE.

Methods

To make research in effective manner, the researchers analysed medical histories of the patients; they also analysed the major costs associated with the treatment of the disease (Olivares, et al, 2009). The researchers considered the medical reports of the data of the 961 patients of the disease for getting idea about the research process. Among the 961 patients, around 45.1% patients are female. The mean age of the patients are around 40.7 years. They also made a set of questions for taking necessary information from the respondents. The researchers also asked questions to their respondents about the history of their disease, treatment processes, and costs of the treatment process.

Findings

It has been observed that Schizophrenia also has an impact on the financial levels as well as health aspects of the people. Data were collected from 961 respondents of the research work. As the respondents of the study belonged to the countries of the CEE, so the results of the research helped the researchers to compare the costs of the treatment of the disease among various countries. Small variations in the mean ages of the patients were seen in the chosen countries.  The highest mean value of the age of the patients were found in Poland which is 42.1 years, the lowest mean value of the ages of the patients in Croatia which is 39.2 years (Olivares, et al, 2009).
It was observed that the largest number of female patients of the country Estonia is suffering from Schizophrenia. The respondent patients of the research work spent around 25.3 days in the hospitals for the treatment process. The research work also stated that the government spent a portion of their GDP or gross domestic products for the treatment processes for the disease. The researchers also included private medical centres besides the governmental health care centres for conducting their research work.  Besides the inpatient services in the hospitals, the patients also require outpatient hospitality services for the treatment of the disease (Fenton and Schooler, 2000).
In addition to this identifying the various costs of the treatment process of Schizophrenia, the researchers also analysed  the total cost of the treatment of  Schizophrenia.  From the analysis of the researchers, the total cost of treatment is the combination of the costs for inpatient costs as well as outpatient costs (Fenton and Schooler, 2000.).

The researchers asked various types of questions to their respondents like total days spent in the hospital for the treatment of the disease, and the number of hospitalization. Besides the patients, the other members of the families of the patients are also suffering from various issues due to the Schizophrenia. Effective treatment procedures should be taken for the proper treatment of the disease (Fenton and Schooler, 2000). The Schizophrenia disease also leads to influence the social aspects of the patients. 

Schizophrenia is considered as one of the serious health issues and as per the WHO (World Health Organisation), the disease is ranked among the serious health problems. The total cost of the treatment of the disease Schizophrenia can be sub divided in to two major types like direct costs and indirect costs (Cuffel, et al, 2016). Besides the direct expenses for the treatment process of the disease, the indirect costs of the health problem also contributes a large portion in the total costs of the treatment of the disease (Green, 2006).

In addition as per the researchers, around 4% relatives of the patients who are suffering from Schizophrenia disease had to stop their own work for providing necessary support to the patients. The disease is also considered as one of the top ten diseases that cause disability of the patients. The total cost of the treatment of the disease varies from country to country (Green, 2006).
The researchers also give a statistical analysis in the context of major diseases that caused disability among the people (Green, 2006). From the analysis of the below table, the top ten major diseases can be easily understood. These diseases rank in the top that caused disability for the patients. 
 
Ranking
Cause
In Millions ( in the percentage value)
1
Unipolar major depression
50.8 (10.7)
2
Iron-deficiency
22.0 (4.7)
3

Falls
22.0 (4.7)
4
Alcoholism
15.8 (3.3)
5
Chronic obstructive pulmonary disease
14.7 (3.1)
6
Bipolar disorder
14.1 (3.0)
7
Congenital abnormalities
13.5 (2.9)
8
Osteoarthritis
13.3 (2.8)
9
Schizophrenia
12.1 (2.6)
10
Obsessive–compulsive disorders
10.2 (2.2)


From the above table, it can be easily understood that schizophrenia is among the top ten diseases that caused disability of the patients. As per the statistical value Schizophrenia ranks nine among the serious health problems. 
As per the statistical data of the developed countries, nearly about only 1% of the total GDP or gross domestic product of the countries are spending for the treatment of the health issues of mental illnesses (Robinson, et al, 2016). As per the health policies of the countries, the government spends a definite sum of their total national income for treatment process of the health problems. As Schizophrenia is considered as one of the major health problems, so the patients also get subsidies for the treatment of the disease in the public hospitals of their counties (Robinson, et al, 2016).
Furthermore, the total cost of the expenses in the treatment of the health issues are of two categories like indirect costs as well as direct costs. In the year 1958, the concept of indirect costs as well as direct costs in the field of treatment processes in health care setting was first introduced by Rashi Fein. According to him, besides the direct expenses, the indirect costs of the health issues are also contributing to the total costs of the illnesses. As per his theory, the direct costs of the treatment of the health issues are the total expenditure for the treatment process and other necessary expenditures related to the treatment of the disease. He also describes the economic loss due to the disease of the patients.

Total cost in Canada and USA

In USA, the GNP or gross national product of the country is near about $ 4,015 billion for the year 1985. The country spends 10 % of their total national income for the treatment processes of the various health issues. Also, around 10% of the total budget of the health costs is being spent for the treatment process of the mental disease. Therefore, for the year 1985, the national spending of the USA for the treatment process of the health issues is near about $ 419 billon. According to the researchers, the estimated costs for the purpose of treatment of the Schizophrenia disease are near about $ 47.5 billion.
Item
Total costs (in $)
Federal costs (in $)
Costs in State and local level (in $)
Cost in Private hospitals (in $)
Treatment and support
42,528
$11,064
$12,115
$19,349
Mental health institutions and Federal providers
12,831
3,097
7,964
1,770
Federal providers
1,433
1,433
----
---
State and local psychiatric hospitals
5,355
777
4,337
241
Private psychiatric hospitals
1,786
270
179
1,337
Other mental health institutions
4,257
617
3,448
192
Other treatment costs
26,458
6,940
3,902
15,616
Short-stay hospitals
8,805
3,575
1,431
3,799
Office-based MDs
2,151
151
54
1,946
Other professionals
3,466
243
86
3,137
Nursing homes
10,583
2,900
2,254
5,429
Drugs
1,453
71
77
1,305
Support costs
3,239
1,027
249
1,963
Lost production
56,660
-
-
-
Morbidity
47,395
-
-
-
Mortality
9,265
-
-
-
Crime, accidents, fire, and social welfare administration
2,003
-
-
-
Time cost of family caregivers
2,500
-

-
Total expenditure
103, 691
-
-
-

The above figure describes the total costs for the various health problems in the USA in the year 1985. By the analysis of the above table, it can be said that the costs of Schizophrenia also contribute a large portion in the total costs of health issues treatment process in the country. Only the direct expenses are considered in this process of making the table of expenses for the treatment of various health issues in USA. Besides Rashi Fein, Rice and his colleagues in the year 1990 also defined the total costs of mental health issues as the combination of the two major types of costs namely direct expenditures as well as indirect expenditures.  
In the direct costs of the treatment of the mental health disease for Schizophrenia is the associated cost for the treatment of the disease. The amount spent for the purpose of drugs, hospital bills, care facilities, professional’s fees and for rehabilitation processes come under the direct expenses of the treatment of the mental health problems. Therefore, the direct costs of the treatment of Schizophrenia are the combined expenditure for medical treatment of the patients. In addition, the indirect costs of mental health issues are the loss in the productivity due to the mental health problems. The productivity loss or reductions in the outputs are also considered as the indirect costs of illnesses. Premature deaths due to the disease Schizophrenia is also considered as the indirect costs of disease.
Besides USA, the government of Canada is also spending a portion of its gross national income for the treatment of Schizophrenia.

Hospital inpatient costs

Hospital inpatient cost is also contributing to a major part in the cost relapse of the disease Schizophrenia. From the inpatient units of the hospitals of the United States, the patients of Schizophrenia were discharged with the short time frame of 90 days. The inpatients costs of index hospitalizations were around $ 2.3 billion in the year 1986. After the post phase of discharge of the patients from the hospital within 2 years, the cost of readmission was $ 2 billion. In the context of treatment process of Schizophrenia, the major way of saving of inpatient costs is the use of suitable strategies for treatment of the disease in effective manner (Mauskopf, et al, 2011).
Cost


Cost for the Six months in the pre-depot initiation
Cost for Six months in the post-depot initiation
Total cost
$11,111.30
$7883.80
Total inpatient cost
$6696.40
$3593.20
Psychiatric inpatient cost
$5384.20
$2537.70
Schizophrenia inpatient cost
$4143.30
$2377.30
Total outpatient cost
$2862.16
$2557.77
Total medication cost
$1552.82
$1732.78

In the above table, the various associated costs for the treatment processes of the Schizophrenia disease is describe in effective manner. The costs of the treatment processes are described above are for the phases of six months in the pre-depot stage as well as in the six months phase of the post depot initiation phase (Chisholm, et al, 2008). From the above analysis, it can be said that inpatient costs contribute to a large portion in the total costs of the treatment of the disease. In the context of treatment of the diseases, the patients get necessary care from the hospitals. The costs required for the inpatient services is classified as hospital inpatient costs. For the treatment of the disease Schizophrenia, the patients also have to spend effective amount as the hospital inpatient costs as the fees for their treatment (Chisholm, et al, 2008).

Hospital outpatient costs

Besides the effective treatment processes in the hospitals the patients also needs effective care in their homes. The effective cares in the homes are classifying as the hospital outpatient services. The required cost for the outpatient services is termed as hospital outpatient costs. In along with the hospital inpatient costs, the hospital outpatient costs are also contributing a significant portion in the total costs of the treatment of the disease Schizophrenia.

Cost relapse in Schizophrenia

The relapse rate of Schizophrenia is about 3.5% on monthly basis if the patients are maintaining narcoleptics. On the other hand, this rate is 11% per month in the cases where the patients discontinue their medication process. The rate of post discharge non-compliance in the community setting is 7.6%. About 257,446 multipleepisode patients who are suffering from Schizophrenia are discharging with in short period of time of 90 days in the year 1986 from a inpatient unit of USA. The cost of index hospitalization is estimated to $2.3 billon. In the initial phase of post discharge, the economic burden is too high. For managing the noncompliance of medication, effective strategies should be taken for providing suitable treatments for pharmacological issues (Cullberg, et  al, 2006). 
The disease not only leads to create difficulties for the patients who are suffering from it but also leads to create various issues for the family members of the patients. In addition, the treatment processes of the disease also require lots of money. In the context of Schizophrenia treatment, the total costs of the treatment are divided in two major parts named as direct expenditure as well as indirect expenditure (Gilmer, et al, 2004). Direct costs indicate the costs related to the costs of professional service, medication, as well as institutional care. On the other hand, the indirect costs imply the low productivity as well as loss for the premature deaths. As per the researchers the annual costs of treatment of Schizophrenia is near about $19 billon.
Type of Inpatient facilities
index cases percentages
Mean of the length of stay ( in days)
Average hospital charge per patient (in $)
Total expenditure (in $ millions)
General
42.9
15.0
7,086
782.5
State
28.8
35.0
11,678
864.6
Veterans
14.1
24.4
8,785
318.3
MMHOs (CMHCs)1
7.7
18.9
6,347
125.3
Private
6.5
19.5
12,366
207.4
All facilities
100.0
22.6
9,252
2,298.1

The above table describes the various aspects in the hospitalization process in the year 1993 including length of stay, index sample, types of various inpatient facilities etc. In the USA, the total costs of inpatient treatment for the patients of Schizophrenia is near about $ 2.3 billion per year for the inpatient services (Gilmer, et al, 2004). Studies also states that the costs in the phase rehospitalisation is near about $ 2 billion. About 63% of the total expenses of the treatment process are due to the loss of medication. The loss of relative contribution is higher in the first year of discharge comparing to the post second year of discharge (Kilian, et al, 2002).

Particulars
Year 1                      

Year 2         
Combined
costs  due to Loss of efficacy
$ 799.7
$399.9
$1,199.6
costs of Noncompliance
$ 370.0
$ 335.1
$ 705.1
Total cost
$ 1,169.7
$ 735.0
$ 1,904.7

Above table illustrates the various costs associated in the treatment processes of the disease Schizophrenia after the post phases of discharge from the hospitals. The total costs of the treatment are the combination of the costs related to the non-compliance as well as loss of efficiency (Kilian, et al, 2002).  The data are taken from a hospital of USA and the data shows the financial report of the year 1993.  The major ways for reducing the related costs of the treatment procedures are implementation of the effective strategies for the process of managing the narcoleptic noncompliance. In addition, development of the effective processes of the pharmacologic treatment procedures also helps to the process of reduction of the total costs of repulse as well as hospital expenditures (Kilian, et al, 2002).

Conclusion

The current paper is based on the costs of Schizophrenia. In this disease, the patients are suffering from various mental problems. Proper medical treatment procedures help the patients to improve their health conditions. For conducting their research work, the researchers take 961 respondents who are suffering from the disease Schizophrenia.  The researchers take various information from their respondents about their health problems. The researchers also consider the social aspects of the patients. As per the researchers, the total costs of the treatment of the disease are the combination of the hospital inpatient costs and hospital outpatient costs. To make the results of the research work more effective, different journal articles were used.  Qualitative data collection method was also used for taking necessary information from the respondents. They asked open-ended questions to their respondents for getting effective outcomes from their study. This study helped the researchers to get effective idea about the total costs of the treatment processes of the disease Schizophrenia.



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