Utilization and costs of health care and early support services in Germany and the influence of mental health burden during the postnatal period

Kass, Benjamin; Roll, Stephanie; Bolster, Marie; Heinrich-Rohr, Michaela; Kuchinke, Lars; Ludwig-Körner, Christiane; Schlensog-Schuster, Franziska; Fricke, Julia; Berghöfer, Anne; Keil, Thomas; Reinhold, Thomas (2024). Utilization and costs of health care and early support services in Germany and the influence of mental health burden during the postnatal period. Children and youth services review, 157, p. 107373. Elsevier 10.1016/j.childyouth.2023.107373

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Limited evidence is available about health care utilization and its determinants in the vulnerable postnatal period for
mothers and their children. Thus, the aim of our analyses was to assess determinants of health care and early support
services utilization regarding mothers and their children and associated costs in the postnatal period in Germany.
Moreover, we aimed to investigate the impact of noticeable mental health and psychosocial burdens on health care
and early support services utilization and costs. Using a two-step assessment process of parents from a randomly
selected sample of 30,000 recently born children in the multicenter observational population-based cohort study of
the SKKIPPI project, we firstly identified mothers who were potentially at risk of mental health and psychosocial
burden. These mothers were then invited to participate in an in-depth assessment, including a detailed self-developed
questionnaire focusing on early support and health care services utilization. A follow-up after 6 months was conducted.
Potential determinants of early support services utilization were analyzed using logistic regression. General
linear models with gamma distribution and log link functions were applied to analyze potential determinants of health
care costs and to estimate mean adjusted costs. Mothers with a noticeable mental health or psychosocial burden and
their children caused mean early support services costs of €1073 and caused total costs of €10,849 in the postnatal
period from a payer’s perspective compared to €349 (early support services) and €9136 (total costs) for mothers
without a noticeable mental health or psychosocial burden and their children. The main determinants of total costs
were facing a chronic disease (child), preterm delivery, bad experiences with doctors and midwives, and single
parenthood. The majority of participants (69 %) utilized some kind of early support services. The most important
determinants of early support service utilization in the postnatal period with respect to the children were facing a
chronic disease, being the first child, and being born as a twin. Our findings highlight the importance of sufficient
appreciation and treatment of mental health problems in the postnatal period from both a societal and payer’s
perspective. Future research should investigate whether these and more specific interventions could be a costeffective
way to support mothers with mental health or psychosocial burden and their children.

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