Long-term effect of war on healthcare costs

In the largest study of its kind, researchers have found that exposure to war and its effect on mental health are linked to a substantial increase in health care costs which remain high many years after the conflict.  

The research from King's College London Institute of Psychiatry, published in this month's PLoS ONE, suggests that costs remain especially high for those who stayed in the conflict zone compared to those who migrated. 

Researchers interviewed over 4,000 people who had experienced war around eight years previously in the former-Yugoslavia – these were mainly from Bosnia-Herzegovina, Croatia, Kosovo, FYR Macedonia, Serbia as well as refugees in Germany, Italy and the UK. 

The project team at the Institute of Psychiatry, Ramon Sabes-Figuera and Professor Paul McCrone, analysed the impact of individual characteristics such as age, sex, mental health status, and exposure to traumatic events before, during and after the wars, on the cost of services. 

In the Balkan countries, individual healthcare costs were increased by 63% if Post-Traumatic Stress Disorder was present and 73% if mood disorders were present. In the West, costs were increased by 77% and 63% with the presence of other anxiety disorders (e.g. phobias, obsessive compulsive disorder) and mood disorders respectively.  

In the Balkans, those with more traumatic events were more likely to have used health services. However in Western countries, exposure to more traumatic events was not linked to an increase in service use.  Reasons for this are uncertain.

Mr Sabes-Figuera, lead author of the study at the IoP, says: ‘So far, little has been known about the costs of healthcare for those involved in or affected by war. Estimating these costs and identifying their predictors can help inform appropriate service planning in the regions directly affected by conflict, and in the areas that welcomed high numbers of refugees. Assessment of these costs becomes even more important in lower income countries with limited health care funds which are disproportionately affected by war.’

The authors conclude that focussing on the mental health impact of war is important for an economic perspective as well as a public health perspective. In planning local mental health services the presence of people affected by war and conflict needs to be taken into account and it should be recognised that economic effects can be prolonged. 

The study was funded by a grant from the European Commission and the principal investigator was Stefan Priebe from Queen Mary College London.

For full paper: Sabes-Figuera, R. et al. ‘Long-term impact of war on healthcare costs: an eight country study’ PLoS ONE (January 2012) doi:10.1371/journal.pone.0029603