Journal of Mental Health Policy and Economics最新文献

Background: Value-based reimbursement (VBR) has become increasingly common among medical practitioners but mental health practitioners (MHPs) have largely remained in fee-for-service (FFS) arrangements. Aligning payment incentives to clinical outcomes rather than volume of services, VBR aspires to achieve health care's quadruple aim, namely improved patient experience, improved population health, reduced costs, and improved work life of health care providers.

Aims of the study: (i) Describe both the historical challenges to implementing VBR for mental health care within the United States, along with the shifting healthcare landscape which now enables VBR arrangements between payers and MHPs; (ii) Highlight considerations for defining quality care and establishing VBR contracting.

Results, discussion and implications: Historically, VBR has been challenging to implement due to a shortage of MHPs in payer networks. Technological challenges such as the absence of electronic medical records required for efficient data analysis and immature data-sharing capabilities, have hindered VBR, as has a culture of clinical practice that relies on clinical intuition as opposed to measured outcomes. VBR is now gaining traction based on overwhelming evidence for measurement-based care, a prerequisite for outcome reporting that larger practices have begun to achieve. Multiple stakeholder organizations have been advocating for measurement-based care. Payers and MHPs can and should collaboratively structure VBR contracts to align greater reimbursements with achievable increases in quality across multiple domains. Contracts can focus on numerous process metrics, such as time to care, treatment adherence, and appropriate avoidance of emergency care, along with clinical and functional outcomes. In some instances, case rates for episodes of care can meanwhile help payer and MHPs transition from FFS to VBR.

Background: Maternal depression is the most prevalent mental health problem worldwide, especially in low- and middle-income countries. It impairs the cognitive, physical, and social abilities of mothers and disturbs effective parenting practices. Therefore, the consequences of mental, physical, and social suffering are not limited to the mother herself but are transmitted to future generations by negatively affecting the child's health.

Aim of the study: This study aims to analyse the relationship between maternal depression and child's physical health in Turkey, a middle-income, developing country.

Methods: By using the 2019 round of the "Turkish Health Survey" dataset prepared by the Turkish Statistical Institute (TurkStat), we focus on the general health status, anaemia prevalence, morbidity of acute respiratory infections (ARI) and diarrhoea along with other common short-term childhood illnesses among under-five children. Maternal depression is assessed by the standardised eight-item version of the Patient Health Questionnaire (PHQ-8). We employ a linear probability model to examine the relationship between maternal depression and the physical health of under-five children. In addition, we investigate the potential protective role of maternal education against the detrimental effects of maternal depression on child health. Since we are simultaneously analysing several outcome measures, in order to avoid any Type I error, we use the novel Romano-Wolf multiple hypothesis testing method.

Results: We find that children whose mothers suffer from mild to severe depression are at a 12 percentage points higher risk of contracting infectious diseases. Similarly, the total number of non-chronic illnesses a child falls victim to increases by one-third if the mother portrays depressive symptoms. In addition, our results suggest that completing at least high school reduces the burdens of maternal depression on children's physical health by 8 percentage points.

Discussion: Considering both the individual and societal burden of infectious disease prevalence, we conclude that the development of worldwide policies and initiatives aimed at decreasing maternal depression as much as increasing maternal education is essential for safeguarding the rights of both women and children, especially in developing countries.

Limitations of the study: The findings of this research provide a linear association between maternal mental health and under-five child's physical health, rather than a causal effect.

Background: The economic cost of perinatal mood and anxiety disorders (PMADs) is high and includes the cost of reduced maternal economic productivity, more preterm births, and increases in other maternal mental health expenditures. PMADs also substantially contribute the cost of maternal morbidity. This paper offers a discussion of the quality-of-care cascade model of PMADs, which outlines care pathways that people typically face as well as gaps and unmet needs that frequently happen along the way. The model uses the US health system as an example. A discussion of international implications follows.

Discussion: The quality-of-care cascade model outlines downward dips in quality of care along the perinatal mental health treatment continuum, including access (many Americans do not have access to affordable health insurance), enrollment (even when individuals are offered health insurance, some do not enroll), coverage (even if individuals have health insurance, some needed services or providers may not be covered), choice (even if services and providers are covered, patients may not be able to choose among plans, institutions, or clinicians), consistency (even if patients have a choice of plan or provider, a consistent source of care may not be accessible), referral (even if care is available and accessible, referral services may not be), quality (even if patients have access to both care and referral services, there may be gaps in the quality of care provided), adherence (even if patients receive high-quality care, they may not be adherent to treatment), barriers (societal forces that may influence people's choices and behaviors), and shocks (unanticipated events that could disrupt care pathways). In describing the quality-of-care cascade model, this paper uses the US healthcare system as the primary example. However, the model can extend to examine quality-of-care dips along the perinatal mental health treatment continuum within the international context. Although the US healthcare system may differ from other healthcare systems in many respects, shared commonalities lead to quality-of-care dips in countries with healthcare systems structured differently than in the US.

Implications for health policies: The global cost of PMADs remains substantial, and addressing the costs of these conditions could have a significant impact on overall cost and quality of care internationally. The quality-of-care cascade model presented in this paper could help identify, understand, and address the complex contributing factors that lead to dips in quality-of-care for perinatal mental health conditions across the world.

Dr. Esther Duflo, Nobel Laureate in Economics, and co-founder and co-director of the Abdul Latif Jameel Poverty Action Lab (J-PAL) sat down with Dr. Benjamin Cook for a "fireside chat" at the 12th National Institute of Mental Health Global Mental Health Research Without Borders Conference. Dr. Duflo discussed J-PAL's efforts to develop and test interventions for improving mental health and how cash transfer programs can be used to improve mental health. She also discussed the importance of using randomized control trials (RCTs) in shaping global mental health initiatives. Dr. Duflo shared insights from projects addressing loneliness among older individuals in India, secondary school scholarships in Ghana, and other studies that have informed social policies. Looking forward, she discusses climate change as a threat to the reductions in poverty realized in the last 30 years and encourages the expansion of networks of research and policy collaborations to improve global health.