Using health production functions to evaluate treatment effectiveness: An application to a community mental health service

The randomized controlled trial (RCT) is the recommended means of evaluatin g health care effectiveness and cost-effectiveness. Whilst representing a ' gold-standard' in health services research, RCT evidence on the clinical an d economic desirability of services and treatments is often absent. Where R CT evidence is lacking, or where it is infeasible to implement randomized c ontrolled comparisons, longitudinal observational and naturalistic data sou rces when analysed appropriately can yield useful insights regarding the cl inical effectiveness and economic efficiency of treatments. In this paper w e demonstrate the utility of applying panel estimation methods to data from an Italian psychiatric case register as a means of modelling the mental he alth outcomes of patients referred to a community-based mental health servi ce. Emphasis is placed on quantifying the clinical effectiveness of consult ations with different mental health professionals (including in-patient day s) and whether service outcomes are affected by psychiatric diagnosis. The impact of service consultations and their interaction with different types of psychiatric diagnosis on a measure of patient mental health are found to be statistically significant, although the size of these effects are not s ubstantial from a clinical perspective. Copyright (C) 2000 John Wiley & Son s, Ltd.