Is psychiatry different? An economic perspective

Perera, Isabel M.

doi:10.1016/s2215-0366(19)30046-x

Cited by 5 publications

(5 citation statements)

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“…In fact, when comparing the relationship between public spending and hospital bed supply (an indicator of overall care supply) in OECD countries, the extent of public general health financing accounts for just 6% of the general bed supply. In contrast, the extent of public mental health financing accounts for almost 40% of the psychiatric bed supply (Perera 2019). In other words, more government spending is associated with more mental health care, but not more general health care.…”

Section: Myth 2: Private Financing Can Fully Replace Public Financingmentioning

confidence: 95%

Myths of Mental Health: Revelations from the French System for the United States

Perera¹,

Barnard²

2021

Perspectives in Biology and Medicine

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Drawing on an analysis of the French mental health system, this essay examines four presumptions about mental health care dominant in the United States: (1) the required abolition of the hospital for psychiatric deinstitutionalization;(2) the substitutability of public and private financing; (3) the importance of a "dangerousness" criterion for involuntary commitment procedures; and (4) the need for an ever-expanding scope of care. These claims hold little weight when subjected to comparative scrutiny, and the essay closes by discussing the implications of these revelations for US mental health care policy and ethics.M ental health systems face competing imperatives to respect patient autonomy, ensure access to long-term comprehensive treatment, and also control costs. In the United States, the system has tilted towards incentivizing private health care providers to deliver voluntary, community-based care. Although some analysts have criticized aspects of this approach, US-based policymakers, researchers, and practitioners tend to view deviations from established policy pat-

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Section: Myth 2: Private Financing Can Fully Replace Public Financingmentioning

confidence: 95%

Myths of Mental Health: Revelations from the French System for the United States

Perera¹,

Barnard²

2021

Perspectives in Biology and Medicine

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“…Revisiting the role of internal institutional conditions on physician preference expression is especially important today, as both the profession and its policy options have fragmented. (Perera 2019). Patient populations hence influence both the type and source of payment that physicians prefer.…”

Section: Contemporary Implications: the Us Casementioning

confidence: 99%

What Doctors Want: A Comment on the Financial Preferences of Organized Medicine

Perera

2021

Journal of Health Politics, Policy and Law

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Organized medicine’s persistent demand for high payments is one factor that contributes to the rising costs of health care. The profession’s longstanding preference for private and fee-for-service practice has pressured payers to increase reimbursement rates in fee-based systems; and it has stalled, thwarted, or otherwise co-opted attempts to contain costs in other payment systems. Yet what doctors want in fact varies. This comment revisits classic comparative studies of organized medicine in the advanced democracies to highlight two underemphasized findings: (1) physicians’ financial preferences can deviate from traditional expectations, and (2) the structure of the organizations that represent doctors can shape whether and how those preferences are expressed. These findings remain relevant today, as a discussion of contemporary American health politics illustrates.

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“…Although members are highly educated and well‐compensated workers, their salaries, political affiliations, and reimbursement preferences can vary widely (Bonica et al, 2014; Hersh & Goldenberg, 2016; Peterson & Burton, 2007; Swenson, 2018). Psychiatry can be a particularly heterogenous specialty; since clients are either unable to afford costly long‐term treatments (and hence are dependent on public generosity) or sufficiently moneyed to cover the substantial out‐of‐pocket health and social care costs associated with mental illness (Perera, 2019). Psychiatrists tend to serve one clientele or the other, with diverging consequences for their policy preferences.…”

Section: Introductionmentioning

confidence: 99%

“…See the references section for a full list of the collections consulted. 7 Unlike the supply of general health care services, the supply of mental health care services depends largely on the extent of public financing(Perera, 2019). 8 Daumezon G.(1947, May).…”

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confidence: 99%

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Interest group governance and policy agendas

Perera

2021

Governance

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This article proposes that the internal political organization of an interest group can shape its policy agenda. In doing so, it recommends that public policy research draw on scholarship on comparative political institutions to identify and theorize how alternative organizational rules, structures, and mechanisms can shape preference formation and expression. For example, confederal interest groups can amplify minority voices, whereas majoritarian groups can silence them. Contrasting cases of physician advocacy in mental health policy illustrate how the confederal approach to medical organization in France expanded the influence of a small group of public sector psychiatrists; while the majoritarian, “winner‐take‐all” approach to medical organization in the United States sidelined their American counterparts in favor of the private sector majority. These findings suggest that the politics of interest‐aggregation merit further investigation.

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Is psychiatry different? An economic perspective

Cited by 5 publications

References 1 publication

Myths of Mental Health: Revelations from the French System for the United States

Myths of Mental Health: Revelations from the French System for the United States

What Doctors Want: A Comment on the Financial Preferences of Organized Medicine

Interest group governance and policy agendas

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