Navigating uncharted waters? How international experience can inform the funding of mental health care in England

Mason, Anne; Goddard, Maria; Myers, Lindsey; Verzulli, Rossella

doi:10.3109/09638237.2011.562261

Cited by 25 publications

(33 citation statements)

References 10 publications

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“…Indeed, this applicability is particularly limited given that only a few other countries (eg, Australia, New Zealand, Canada, the Netherlands, Norway, USA) have made progress implementing mental health payment systems, using heterogeneous clustering and resource distribution methodologies. 23 Fourth, the Figure 2 Frequency of HSU prediction by variable category. HSU, health service utilisation; frequencies were obtained by counting some studies various times for one variable category; for interventions, the count concerned the prediction of decreased HSU.…”

Section: Methodological Considerationsmentioning

confidence: 99%

A Systematic Review of the Predictors of Health Service Utilisation by Adults with Mental Disorders in the UK

Twomey

Baldwin

Hopfe

et al. 2015

European Psychiatry

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Objectives: To identify variables that predict health service utilisation (HSU) by adults with mental disorders in the UK, and to determine the evidence level for these predictors.Design: A narrative synthesis of peer-reviewed studies published after the year 2000. The search was conducted using four databases (ie, PsycINFO, CINAHL Plus with full text, MEDLINE and EMBASE) and completed on 25 March 2014. Setting:The majority of included studies were set in health services across primary, secondary, specialist and inpatient care. Some studies used data from household and postal surveys.Participants: Included were UK-based studies that predicted HSU by adults with mental disorders. Participants had a range of mental disorders including psychotic disorders, personality disorders, depression, anxiety disorders, eating disorders and dementia.Primary outcome: A wide range of HSU outcomes were examined, including general practitioner (GP) contacts, medication usage, psychiatrist contacts, psychotherapy attendances, inpatient days, accident and emergency admissions and 'total HSU'.Results: Taking into account study quality, 28 studies identified a range of variables with good preliminary evidence supporting their ability to predict HSU. Of these variables, comorbidity, personality disorder, age (heterogeneous age ranges), neurotic symptoms, female gender, a marital status of divorced, separated or widowed, non-white ethnicity, high previous HSU and activities of daily living, were associated with increased HSU. Moreover, good preliminary evidence was found for associations of accessing a primary care psychological treatment service and medication use with decreased HSU.

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Section: Methodological Considerationsmentioning

confidence: 99%

A Systematic Review of the Predictors of Health Service Utilisation by Adults with Mental Disorders in the UK

Twomey

Baldwin

Hopfe

et al. 2015

European Psychiatry

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“…7 Achieving homogeneity within clusters is considered essential to ensure that PbR will not introduce financial risk for providers. 8,9 This was the primary reason why similar approaches to payment were not implemented for mental health services in the USA, Australia or New Zealand. [9][10][11] Similarly, initial cost analyses in the UK demonstrated that homogeneity within clusters was 'unacceptably low' and that providers vary in their resource utilisation much more than what could be explained by differences in their case-load.…”

Section: Discussionmentioning

confidence: 99%

Payment by results: validating care cluster allocation in the real world

Bekas

Michev

2013

Psychiatrist

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Aims and methodTo validate care cluster allocation for payment by results (PbR) in mental health and to evaluate clustering and auditing methodologies. We applied exclusion criteria to the patient population of a mental health trust. An automated validation compared cluster with expected ICD-10 codes or scores on the Health of the Nation Outcome Scales (HoNOS) and Mental Health Clustering Tool (MHCT). Six hundred ‘mismatched’ cases were reviewed in depth to better understand the reasons why these cases appeared misclustered.ResultsThere was a significant mismatch between ICD-10 codes, HoNOS and MHCT scores and allocated care cluster, with differences between services and localities. Some clusters appeared to be more accurately allocated. The ‘deep dive’ analysis indicated that most mismatches occurred because psychosis was allocated to a non-psychotic cluster and vice versa, but also as a result of inherent weaknesses of the MHCT.Clinical implicationsHigh levels of inappropriate care cluster allocation highlight the need to improve practice. Weaknesses in the MHCT and ICD-10 coding mean that the final arbiter should be clinical judgement. Auditing will, by necessity, have a significant margin of error.

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“…At present, NHS mental health services are primarily funded through block contracts agreed between commissioners and providers of care, or on the basis of levels of existing 'inputs' such as the number of beds (Mason 2011a). This method of financing, often termed retrospective reimbursement, offers little incentive for providers to deliver an efficient level of care (Mason 2011a) because it does not encourage them to control costs or increase output (activity levels).…”

Section: Retrospective Reimbursementmentioning

confidence: 99%

“…This method of financing, often termed retrospective reimbursement, offers little incentive for providers to deliver an efficient level of care (Mason 2011a) because it does not encourage them to control costs or increase output (activity levels). This is because an agreed fixed sum is paid regardless of the number of patients treated.…”

Section: Retrospective Reimbursementmentioning

confidence: 99%

Payment by results for mental health services: economic considerations of case-mix funding

Jacobs¹

2014

Adv. psychiatr. treat

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SummaryAgainst the backdrop of a tight financial climate, a new method of funding mental health services is being rolled out in England's National Health Service. Called payment by results (PbR), it represents a fundamental change to the way providers of psychiatric services are paid for care of patients. The Mental Health Clustering Tool has been developed to capture activity which reflects the relative needs of patients, and cluster costs are being collected by service providers. The ultimate goal is the creation of a national tariff or fixed price for each cluster. This article describes the incentives generated by PbR and gives evidence on PbR in acute physical care services where it has been in operation for a decade, with respect to efficiency, quality, volume of activity, administrative costs, upcoding or gaming, equity of provision, and cross-subsidisation. It explores the challenges for mental health services as PbR is introduced.LEARNING OBJECTIVESUnderstand the difference between retrospective and prospective reimbursement systems and the incentives generated by each financing system.Understand the three key building blocks of PbR: currency, reference costs and tariffs.Consider the evidence on PbR in acute physical care and the implications for mental health services.

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Navigating uncharted waters? How international experience can inform the funding of mental health care in England

Abstract: New payment systems must account for the economic incentives they embody, and appropriate adjustments for variations in length of stay are essential.

Cited by 25 publications

References 10 publications

A Systematic Review of the Predictors of Health Service Utilisation by Adults with Mental Disorders in the UK

A Systematic Review of the Predictors of Health Service Utilisation by Adults with Mental Disorders in the UK

Payment by results: validating care cluster allocation in the real world

Payment by results for mental health services: economic considerations of case-mix funding

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