71 Patient cost-sharing, mental health care and inequalities Table 1. Evolution of the annual compulsory deductible between 2009 and 2014 Year 2009 2010 2011 2012 2013 2014 Deductible (euros) 155 165 170 220 350 360 Deductible (euros, in 2015 prices)a 171 180 181 229 356 362 Notes: a Adjusted by the Consumer Price Index with reference to 2015 (CBS 2020), category all expenditures. In addition to the compulsory deductible, individuals can opt for a voluntary deductible. This consists of an amount that ranges between 100 and 500 euros, in exchange for discounts to the premium. The proportion of Dutch adults opting for a voluntary deductible was low (from 6% in 2010 increased to 10% in 2014) [27]. Dutch mental health care system Curative mental health services were introduced in the Health Insurance Act in 2008, bringing mental health care under the predefined insurance benefit package and making the compulsory deductible applicable to its costs. Additional information about youth mental health and the transitional boundary between CAMHS and AMHS is provided in appendixes A.1 and A.2. The Dutch curative mental health care sector can be divided in two segments, which were reorganised in 2014 (see appendix A for more details) [28]. Basic mental health care, previously designated as primary line, is provided in the outpatient setting mostly by psychologists, psychotherapists and geriatric specialists. It aims at treating patients with mild and moderate mental health disorders. Specialist care, previously designated as second line, is both outpatient and inpatient and is provided by clinical psychologists, psychiatrists and multidisciplinary teams, often within large mental health care providers. It focuses on the most severe mental disorders and complex patients, including those that have several diagnoses/comorbidities or pose a risk to themselves/others [25]. Outside of the mental health care sector, general practitioners (GPs) and mental health nurses working in primary care provide short-term support to patients with minor psychological complaints, and act as gatekeepers for mental health services. They refer patients to either basic or specialist mental health care when suspecting of a mental health disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) [25]. METHODS Data sources and study population We use de-identified administrative records from Statistics Netherlands covering the entire Dutch population (see appendix B for details on the datasets). Based on municipal registry datasets we identify individuals born between 1990 and 1997 who lived in the Netherlands during 2009, and observe their year and month of birth, gender, migratory background and home address postcode. For each individual, we link these demographic 3
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