Reforming the Portuguese mental health system
Funding agency: Norway, Iceland (grant nr.00065SM1), Liechtenstein, through the EEA grants and ACSS Background: To promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care...
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Online Access: | http://www.scopus.com/inward/record.url?scp=85047923888&partnerID=8YFLogxK https://doi.org/10.1186/s13033-018-0204-4 |
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ftnewulisboa:oai:run.unl.pt:10362/41782 2023-05-15T16:53:10+02:00 Reforming the Portuguese mental health system an incentive-based approach Perelman, Julian Chaves, Pedro de Almeida, José Miguel Caldas Matias, Maria Ana Escola Nacional de Saúde Pública (ENSP) NOVA School of Business and Economics (NOVA SBE) 2018-05-30 http://www.scopus.com/inward/record.url?scp=85047923888&partnerID=8YFLogxK https://doi.org/10.1186/s13033-018-0204-4 eng eng 1752-4458 PURE: 4353704 PURE UUID: 1c2755de-5f64-4d94-abaf-cc72b602e1aa Scopus: 85047923888 WOS: 000433600500001 http://www.scopus.com/inward/record.url?scp=85047923888&partnerID=8YFLogxK https://doi.org/10.1186/s13033-018-0204-4 openAccess Access Innovative payment Mental health Primary care Phychiatric Mental Health Health Policy Public Health Environmental and Occupational Health Psychiatry and Mental health SDG 3 - Good Health and Well-being article 2018 ftnewulisboa https://doi.org/10.1186/s13033-018-0204-4 2022-05-01T14:06:22Z Funding agency: Norway, Iceland (grant nr.00065SM1), Liechtenstein, through the EEA grants and ACSS Background: To promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care for serious mental illnesses. Despite a prevalence of lifetime mental health disorders above 30%, Portugal is failing to achieve such recommendations. It was argued that this failure is partly due to inadequate financing mechanisms of mental health care providers. This study proposes an innovative payment model for mental health providers oriented toward incentivising best practices. Methods: We performed a comprehensive review of healthcare providers' payment schemes and their related incentives, and a narrative review of best practices in mental health prevention and care. We designed an alternative payment model, on the basis of the literature, and then we presented it individually, through face-to-face interviews, to a panel of 22 experts with different backgrounds and experience, and from southern and northern Portuguese regions, asking them to comment on the model and provide suggestions. Then, after a first round of interviews, we revised our model, which we presented to experts again for their approval, and provide new suggestions and comments, if deemed necessary. This approach is close to what is generally known as the Delphi technique, although it was not applied in a rigid way. Results: We designed a four-dimension model that focused on (i) the prevention of mental disorders early in life; (ii) the detection of mental disorders in childhood and adolescence; (iii) the implementation of a collaborative stepped care model for depression; and (iv) the integrated community-based care for patients with serious mental illnesses. First, we recommend a bundled payment to primary care practices for the follow-up of children with special needs or at risk under 2 years of age. Second, we propose a pay-for-performance scheme for all primary care practices, based on the number of users under 18 years old who are provided with check-up consultations. Third, we propose a pay-for-performance scheme for all primary care practices, based on the implementation of collaborative stepped care for depression. Finally, we propose a value-based risk-adjusted bundled payment for patients with serious mental illness. Conclusions: The implementation of evidence-based best practices in mental health needs to be supported by adequate payment mechanisms. Our study shows that mental health experts, including decision makers, agree with using economic tools to support best practices, which were also consensual. publishersversion published Article in Journal/Newspaper Iceland Repositório da Universidade Nova de Lisboa (UNL) Norway International Journal of Mental Health Systems 12 1 |
institution |
Open Polar |
collection |
Repositório da Universidade Nova de Lisboa (UNL) |
op_collection_id |
ftnewulisboa |
language |
English |
topic |
Access Innovative payment Mental health Primary care Phychiatric Mental Health Health Policy Public Health Environmental and Occupational Health Psychiatry and Mental health SDG 3 - Good Health and Well-being |
spellingShingle |
Access Innovative payment Mental health Primary care Phychiatric Mental Health Health Policy Public Health Environmental and Occupational Health Psychiatry and Mental health SDG 3 - Good Health and Well-being Perelman, Julian Chaves, Pedro de Almeida, José Miguel Caldas Matias, Maria Ana Reforming the Portuguese mental health system |
topic_facet |
Access Innovative payment Mental health Primary care Phychiatric Mental Health Health Policy Public Health Environmental and Occupational Health Psychiatry and Mental health SDG 3 - Good Health and Well-being |
description |
Funding agency: Norway, Iceland (grant nr.00065SM1), Liechtenstein, through the EEA grants and ACSS Background: To promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care for serious mental illnesses. Despite a prevalence of lifetime mental health disorders above 30%, Portugal is failing to achieve such recommendations. It was argued that this failure is partly due to inadequate financing mechanisms of mental health care providers. This study proposes an innovative payment model for mental health providers oriented toward incentivising best practices. Methods: We performed a comprehensive review of healthcare providers' payment schemes and their related incentives, and a narrative review of best practices in mental health prevention and care. We designed an alternative payment model, on the basis of the literature, and then we presented it individually, through face-to-face interviews, to a panel of 22 experts with different backgrounds and experience, and from southern and northern Portuguese regions, asking them to comment on the model and provide suggestions. Then, after a first round of interviews, we revised our model, which we presented to experts again for their approval, and provide new suggestions and comments, if deemed necessary. This approach is close to what is generally known as the Delphi technique, although it was not applied in a rigid way. Results: We designed a four-dimension model that focused on (i) the prevention of mental disorders early in life; (ii) the detection of mental disorders in childhood and adolescence; (iii) the implementation of a collaborative stepped care model for depression; and (iv) the integrated community-based care for patients with serious mental illnesses. First, we recommend a bundled payment to primary care practices for the follow-up of children with special needs or at risk under 2 years of age. Second, we propose a pay-for-performance scheme for all primary care practices, based on the number of users under 18 years old who are provided with check-up consultations. Third, we propose a pay-for-performance scheme for all primary care practices, based on the implementation of collaborative stepped care for depression. Finally, we propose a value-based risk-adjusted bundled payment for patients with serious mental illness. Conclusions: The implementation of evidence-based best practices in mental health needs to be supported by adequate payment mechanisms. Our study shows that mental health experts, including decision makers, agree with using economic tools to support best practices, which were also consensual. publishersversion published |
author2 |
Escola Nacional de Saúde Pública (ENSP) NOVA School of Business and Economics (NOVA SBE) |
format |
Article in Journal/Newspaper |
author |
Perelman, Julian Chaves, Pedro de Almeida, José Miguel Caldas Matias, Maria Ana |
author_facet |
Perelman, Julian Chaves, Pedro de Almeida, José Miguel Caldas Matias, Maria Ana |
author_sort |
Perelman, Julian |
title |
Reforming the Portuguese mental health system |
title_short |
Reforming the Portuguese mental health system |
title_full |
Reforming the Portuguese mental health system |
title_fullStr |
Reforming the Portuguese mental health system |
title_full_unstemmed |
Reforming the Portuguese mental health system |
title_sort |
reforming the portuguese mental health system |
publishDate |
2018 |
url |
http://www.scopus.com/inward/record.url?scp=85047923888&partnerID=8YFLogxK https://doi.org/10.1186/s13033-018-0204-4 |
geographic |
Norway |
geographic_facet |
Norway |
genre |
Iceland |
genre_facet |
Iceland |
op_relation |
1752-4458 PURE: 4353704 PURE UUID: 1c2755de-5f64-4d94-abaf-cc72b602e1aa Scopus: 85047923888 WOS: 000433600500001 http://www.scopus.com/inward/record.url?scp=85047923888&partnerID=8YFLogxK https://doi.org/10.1186/s13033-018-0204-4 |
op_rights |
openAccess |
op_doi |
https://doi.org/10.1186/s13033-018-0204-4 |
container_title |
International Journal of Mental Health Systems |
container_volume |
12 |
container_issue |
1 |
_version_ |
1766043681174847488 |