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Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance

BACKGROUND: Adult attention-deficit hyperactivity disorder (ADHD) is a chronic, costly and debilitating disorder. In South Africa (SA), access to funding for care and treatment of ADHD is limited, and research is lacking. AIM: This study aimed to establish the current situation with regard to the ps...

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Autores principales: Schoeman, Renata, de Klerk, Manie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AOSIS 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6138168/
https://www.ncbi.nlm.nih.gov/pubmed/30263184
http://dx.doi.org/10.4102/sajpsychiatry.v23.1010
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author Schoeman, Renata
de Klerk, Manie
author_facet Schoeman, Renata
de Klerk, Manie
author_sort Schoeman, Renata
collection PubMed
description BACKGROUND: Adult attention-deficit hyperactivity disorder (ADHD) is a chronic, costly and debilitating disorder. In South Africa (SA), access to funding for care and treatment of ADHD is limited, and research is lacking. AIM: This study aimed to establish the current situation with regard to the psychiatric management of and funding for treatment of adult ADHD in the private sector in SA. METHODS: A diagnostically refined retrospective claims database analysis was conducted. We examined the prevalence, costs and funding profile of claims over a 2-year period for adult beneficiaries with possible ADHD of a large medical administrator in SA. RESULTS: The prevalence of adult ADHD was lower than published international rates. The presence of adult ADHD increased the prevalence of comorbidity and doubled the health care costs of beneficiaries. Contrary to public belief, comorbidities (including their medicine costs) rather than psychiatric services or medicines were the main cost drivers. CONCLUSION: The current private health insurance funding model for ADHD limits access to funding. This affects early diagnosis and optimal treatment, thereby escalating long-term costs. Improved outcomes are possible if patients suffering from ADHD receive timely and accurate diagnosis, and receive chronic and comprehensive care. Balanced regulation is proposed to minimise the risk to both medical schemes and patients. A collaborative approach between stakeholders is needed to develop an alternative cost-effective funding model to improve access to treatment and quality of life for adults with ADHD in SA.
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spelling pubmed-61381682018-09-27 Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance Schoeman, Renata de Klerk, Manie S Afr J Psychiatr Original Research BACKGROUND: Adult attention-deficit hyperactivity disorder (ADHD) is a chronic, costly and debilitating disorder. In South Africa (SA), access to funding for care and treatment of ADHD is limited, and research is lacking. AIM: This study aimed to establish the current situation with regard to the psychiatric management of and funding for treatment of adult ADHD in the private sector in SA. METHODS: A diagnostically refined retrospective claims database analysis was conducted. We examined the prevalence, costs and funding profile of claims over a 2-year period for adult beneficiaries with possible ADHD of a large medical administrator in SA. RESULTS: The prevalence of adult ADHD was lower than published international rates. The presence of adult ADHD increased the prevalence of comorbidity and doubled the health care costs of beneficiaries. Contrary to public belief, comorbidities (including their medicine costs) rather than psychiatric services or medicines were the main cost drivers. CONCLUSION: The current private health insurance funding model for ADHD limits access to funding. This affects early diagnosis and optimal treatment, thereby escalating long-term costs. Improved outcomes are possible if patients suffering from ADHD receive timely and accurate diagnosis, and receive chronic and comprehensive care. Balanced regulation is proposed to minimise the risk to both medical schemes and patients. A collaborative approach between stakeholders is needed to develop an alternative cost-effective funding model to improve access to treatment and quality of life for adults with ADHD in SA. AOSIS 2017-01-31 /pmc/articles/PMC6138168/ /pubmed/30263184 http://dx.doi.org/10.4102/sajpsychiatry.v23.1010 Text en © 2017. The Authors http://creativecommons.org/licenses/by/2.0/ AOSIS. This work is licensed under the Creative Commons Attribution License.
spellingShingle Original Research
Schoeman, Renata
de Klerk, Manie
Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance
title Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance
title_full Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance
title_fullStr Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance
title_full_unstemmed Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance
title_short Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance
title_sort adult attention-deficit hyperactivity disorder: a database analysis of south african private health insurance
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6138168/
https://www.ncbi.nlm.nih.gov/pubmed/30263184
http://dx.doi.org/10.4102/sajpsychiatry.v23.1010
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