Pub Date : 2000-11-23DOI: 10.1002/1099-176X(200006)3:2<69::AID-MHP76>3.0.CO;2-1
Howard H. Goldman, Sten Thelander, Claes-Goran Westrin
<div> <section> <h3> <b>Background and Aims.</b></h3> <p> Health policy makers and program developers seek evidence-based guidance on how to organize and finance mental health services. The Swedish Council on Technology Assessment in Health Care (SBU) commissioned a conceptual framework for thinking about health care services as a medical technology. The following framework was developed, citing empirical research from mental health services research as the case example.</p> </section> <section> <h3> <b>Framework.</b></h3> <p> Historically, mental health services have focused on the organization and locus of care. Health care settings have been conceptualized as medical technologies, treatments in themselves. For example, the field speaks of an era of ‘asylum treatment’ and ‘community care’. Hospitals and community mental health centers are viewed as treatments with indications and ‘dosages’, such as length of stay criteria. Assessment of mental health services often has focused on organizations and on administrative science.</p> <p>There are two principal perspectives for assessing the contribution of the organization of services on health. One perspective is derived from clinical services research, in which the focus is on the impact of organized treatments (and their most common settings) on health status of individuals. The other perspective is based in service systems research, in which the focus is on the impact of organizational strategies on intermediate service patterns, such as continuity of care or integration, as well as health status.</p> </section> <section> <h3> <b>Methods.</b></h3> <p> Examples of empirical investigations from clinical services research and service systems research are presented to demonstrate potential sources of evidence to support specific decisions for organizing mental health services.</p> </section> <section> <h3> <b>Results.</b></h3> <p> Evidence on organizing mental health services may be found in both types of services research. In clinical services research studies, service settings are viewed as treatments (e.g. ‘partial hospitalization’), some treatments are always embedded in a service matrix (e.g. assertive community treatment), and, where some treatments are organizationally combined (e.g. ‘integrated treatment’ for co-occurring mental disorder and substance abuse), sometimes into a continuum of care. In service system research, integration of services and of the service system are the main focus of investigation. Studies focus on horizontal and vertical integration, primary care or specialty care and local mental health authorities—each of which ma
{"title":"Organizing mental health services: an evidence-based approach","authors":"Howard H. Goldman, Sten Thelander, Claes-Goran Westrin","doi":"10.1002/1099-176X(200006)3:2<69::AID-MHP76>3.0.CO;2-1","DOIUrl":"https://doi.org/10.1002/1099-176X(200006)3:2<69::AID-MHP76>3.0.CO;2-1","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> <b>Background and Aims.</b></h3>\u0000 \u0000 <p> Health policy makers and program developers seek evidence-based guidance on how to organize and finance mental health services. The Swedish Council on Technology Assessment in Health Care (SBU) commissioned a conceptual framework for thinking about health care services as a medical technology. The following framework was developed, citing empirical research from mental health services research as the case example.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> <b>Framework.</b></h3>\u0000 \u0000 <p> Historically, mental health services have focused on the organization and locus of care. Health care settings have been conceptualized as medical technologies, treatments in themselves. For example, the field speaks of an era of ‘asylum treatment’ and ‘community care’. Hospitals and community mental health centers are viewed as treatments with indications and ‘dosages’, such as length of stay criteria. Assessment of mental health services often has focused on organizations and on administrative science.</p>\u0000 \u0000 <p>There are two principal perspectives for assessing the contribution of the organization of services on health. One perspective is derived from clinical services research, in which the focus is on the impact of organized treatments (and their most common settings) on health status of individuals. The other perspective is based in service systems research, in which the focus is on the impact of organizational strategies on intermediate service patterns, such as continuity of care or integration, as well as health status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> <b>Methods.</b></h3>\u0000 \u0000 <p> Examples of empirical investigations from clinical services research and service systems research are presented to demonstrate potential sources of evidence to support specific decisions for organizing mental health services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> <b>Results.</b></h3>\u0000 \u0000 <p> Evidence on organizing mental health services may be found in both types of services research. In clinical services research studies, service settings are viewed as treatments (e.g. ‘partial hospitalization’), some treatments are always embedded in a service matrix (e.g. assertive community treatment), and, where some treatments are organizationally combined (e.g. ‘integrated treatment’ for co-occurring mental disorder and substance abuse), sometimes into a continuum of care. In service system research, integration of services and of the service system are the main focus of investigation. Studies focus on horizontal and vertical integration, primary care or specialty care and local mental health authorities—each of which ma","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 2","pages":"69-75"},"PeriodicalIF":1.6,"publicationDate":"2000-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200006)3:2<69::AID-MHP76>3.0.CO;2-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72162501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-11-23DOI: 10.1002/1099-176X(200006)3:2<97::AID-MHP77>3.0.CO;2-S
Nancy Wolff
<div> <section> <h3> <b>Background:</b></h3> <p> Following the lead of evidence-based medicine, practice based on effectiveness research has become the new gold standard of contemporary public policy. Studies of this sort are increasingly demanded to evaluate services provided by mental health, social services and criminal justice systems.</p> </section> <section> <h3> <b>Aims:</b></h3> <p> The paper questions whether the simple randomized controlled trial (RCT) paradigm as applied in clinical trials can be used ‘off the rack’ to evaluate <i>socially complex service (SCS) interventions</i>. These are services that are characterized by complex, diverse and non-standardized staffing arrangements; ambiguous protocols; hard-to-define study samples and unevenly motivated subjects and dependence on broader social environments. The difficulty of ensuring precise protocols, equivalent groups (tied to a meaningful target population) and neutral and equivalent trial environments under real world conditions are explored, as are the implications of not achieving standardization and equivalence.</p> </section> <section> <h3> <b>Methods:</b></h3> <p> Limitations of effectiveness research as a research tool and information source are examined by comparing the assumptions underpinning the simple RCT to the characteristics of SCS interventions, as illustrated by programs targeted to mentally disordered offenders in Britain.</p> </section> <section> <h3> <b>Results:</b></h3> <p> SCSs violate the assumptions underpinning the simple RCT model in ways that draw into sharp question the validity, reliability and generalizability of inferences of SCS trials.</p> </section> <section> <h3> <b>Discussion:</b></h3> <p> The RCT is not a panacea. Effectiveness research of SCS interventions that is based on the RCT model is unlikely to yield valid, reliable and generalizable inferences without becoming more complex in design and more sensitive to issues of selection bias, unmeasured variables and endogeneity. Ten recommendations are offered for stylizing the RCT design to the characteristics of socially complex services.</p> </section> <section> <h3> <b>Implications:</b></h3> <p> It remains an empirical issue whether RCT-based services effectiveness research can inform mental health policy. Without major design innovations, it is more likely that the information generated by this research will have limited practical use, especially if the RCT model is unable to control for the effect of socia
{"title":"Using randomized controlled trials to evaluate socially complex services: problems, challenges and recommendations","authors":"Nancy Wolff","doi":"10.1002/1099-176X(200006)3:2<97::AID-MHP77>3.0.CO;2-S","DOIUrl":"https://doi.org/10.1002/1099-176X(200006)3:2<97::AID-MHP77>3.0.CO;2-S","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> <b>Background:</b></h3>\u0000 \u0000 <p> Following the lead of evidence-based medicine, practice based on effectiveness research has become the new gold standard of contemporary public policy. Studies of this sort are increasingly demanded to evaluate services provided by mental health, social services and criminal justice systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> <b>Aims:</b></h3>\u0000 \u0000 <p> The paper questions whether the simple randomized controlled trial (RCT) paradigm as applied in clinical trials can be used ‘off the rack’ to evaluate <i>socially complex service (SCS) interventions</i>. These are services that are characterized by complex, diverse and non-standardized staffing arrangements; ambiguous protocols; hard-to-define study samples and unevenly motivated subjects and dependence on broader social environments. The difficulty of ensuring precise protocols, equivalent groups (tied to a meaningful target population) and neutral and equivalent trial environments under real world conditions are explored, as are the implications of not achieving standardization and equivalence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> <b>Methods:</b></h3>\u0000 \u0000 <p> Limitations of effectiveness research as a research tool and information source are examined by comparing the assumptions underpinning the simple RCT to the characteristics of SCS interventions, as illustrated by programs targeted to mentally disordered offenders in Britain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> <b>Results:</b></h3>\u0000 \u0000 <p> SCSs violate the assumptions underpinning the simple RCT model in ways that draw into sharp question the validity, reliability and generalizability of inferences of SCS trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> <b>Discussion:</b></h3>\u0000 \u0000 <p> The RCT is not a panacea. Effectiveness research of SCS interventions that is based on the RCT model is unlikely to yield valid, reliable and generalizable inferences without becoming more complex in design and more sensitive to issues of selection bias, unmeasured variables and endogeneity. Ten recommendations are offered for stylizing the RCT design to the characteristics of socially complex services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> <b>Implications:</b></h3>\u0000 \u0000 <p> It remains an empirical issue whether RCT-based services effectiveness research can inform mental health policy. Without major design innovations, it is more likely that the information generated by this research will have limited practical use, especially if the RCT model is unable to control for the effect of socia","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 2","pages":"97-109"},"PeriodicalIF":1.6,"publicationDate":"2000-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200006)3:2<97::AID-MHP77>3.0.CO;2-S","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72162503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-11-23DOI: 10.1002/1099-176X(200006)3:2<115::AID-MHP84>3.0.CO;2-H
To view the abstracts translations in Russian please go to the full text PDF file.
要查看俄语摘要翻译，请访问全文PDF文件。
{"title":"Abstracts translations","authors":"","doi":"10.1002/1099-176X(200006)3:2<115::AID-MHP84>3.0.CO;2-H","DOIUrl":"https://doi.org/10.1002/1099-176X(200006)3:2<115::AID-MHP84>3.0.CO;2-H","url":null,"abstract":"<p>To view the abstracts translations in Russian please go to the full text PDF file.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 2","pages":"115-117"},"PeriodicalIF":1.6,"publicationDate":"2000-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200006)3:2<115::AID-MHP84>3.0.CO;2-H","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72162500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Addiction:entries and exits. Edited by Jon Elster. New York: Sage, 1999","authors":"R. Pacula","doi":"10.1002/MHP.92","DOIUrl":"https://doi.org/10.1002/MHP.92","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 1","pages":"165-166"},"PeriodicalIF":1.6,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78740860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-19DOI: 10.1002/1099-176X(200003)3:1<11::AID-MHP66>3.0.CO;2-0
William S. Cartwright
<div> <section> <h3> Background:</h3> <p>How valuable is public investment in treatment for drug abuse and dependency in the real world of everyday practice? Does drug abuse treatment provide benefits and how are they valued? What are the costs of obtaining outcomes and benefits? Cost–benefit analysis attempts to answer these questions in a standard analytic framework.</p> </section> <section> <h3> Aims:</h3> <p>This paper reviews cost–benefit analyses with scientific merit so that analysts will have a current picture of the state of the research. It will also give public decision-makers information with regards to the available evidence for policy purposes.</p> </section> <section> <h3> Method:</h3> <p>Bibliographic searches were performed. Studies were obtained through the assistance of the Parklawn Health Library system, a component of the US Public Health Service. Selected studies were from the scientific literature with the exception of eight studies published as governmental reports.</p> </section> <section> <h3> Results:</h3> <p>Cost–benefit studies have fallen into the following categories: (i) planning models for delivery systems in states and cities; (ii) short-term follow-up studies of individuals, (iii) single individual programs and (iv) state system's monitoring of outcomes. In 18 cost–benefit studies, a persistent finding is that benefits exceed costs, even when not all benefits are accounted for in the analysis. Much variation is found in the implementation of cost–benefit methods, and this is detailed across discussions of effectiveness, benefits and costs. Studies have emphasized the cost savings to society from the reduction in external costs created by the behavioral consequences of addiction and drug use.</p> </section> <section> <h3> Discussion:</h3> <p>Economic analysis of drug treatment requires sophisticated conceptualization and measurement. Cost–benefit analysis of drug treatment has been a significant analytical exercise since the early 1970s when the public drug treatment system was founded in the United States.</p> </section> <section> <h3> Conclusion:</h3> <p>Drug abuse treatment services may be considered as contributing positive economic returns to society. However, considerable work needs to be done to standardize methods used in the studies. A striking area of omission is the absence of studies for adolescents and only one for women in treatment.</p> </section> <section> <
{"title":"Cost–benefit analysis of drug treatment services: review of the literature†","authors":"William S. Cartwright","doi":"10.1002/1099-176X(200003)3:1<11::AID-MHP66>3.0.CO;2-0","DOIUrl":"https://doi.org/10.1002/1099-176X(200003)3:1<11::AID-MHP66>3.0.CO;2-0","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background:</h3>\u0000 \u0000 <p>How valuable is public investment in treatment for drug abuse and dependency in the real world of everyday practice? Does drug abuse treatment provide benefits and how are they valued? What are the costs of obtaining outcomes and benefits? Cost–benefit analysis attempts to answer these questions in a standard analytic framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims:</h3>\u0000 \u0000 <p>This paper reviews cost–benefit analyses with scientific merit so that analysts will have a current picture of the state of the research. It will also give public decision-makers information with regards to the available evidence for policy purposes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method:</h3>\u0000 \u0000 <p>Bibliographic searches were performed. Studies were obtained through the assistance of the Parklawn Health Library system, a component of the US Public Health Service. Selected studies were from the scientific literature with the exception of eight studies published as governmental reports.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>Cost–benefit studies have fallen into the following categories: (i) planning models for delivery systems in states and cities; (ii) short-term follow-up studies of individuals, (iii) single individual programs and (iv) state system's monitoring of outcomes. In 18 cost–benefit studies, a persistent finding is that benefits exceed costs, even when not all benefits are accounted for in the analysis. Much variation is found in the implementation of cost–benefit methods, and this is detailed across discussions of effectiveness, benefits and costs. Studies have emphasized the cost savings to society from the reduction in external costs created by the behavioral consequences of addiction and drug use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion:</h3>\u0000 \u0000 <p>Economic analysis of drug treatment requires sophisticated conceptualization and measurement. Cost–benefit analysis of drug treatment has been a significant analytical exercise since the early 1970s when the public drug treatment system was founded in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion:</h3>\u0000 \u0000 <p>Drug abuse treatment services may be considered as contributing positive economic returns to society. However, considerable work needs to be done to standardize methods used in the studies. A striking area of omission is the absence of studies for adolescents and only one for women in treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 1","pages":"11-26"},"PeriodicalIF":1.6,"publicationDate":"2000-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200003)3:1<11::AID-MHP66>3.0.CO;2-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72157708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND: Depression is one of the most ancient and common diseases of the human race and its burden on society is really impressive. This stems both from the epidemiological spread (lifetime prevalence rate, up to 30 years of age, was estimated as greater than 14.4% by Angst et al.) and from the economic burden on healthcare systems and society, but also as it pertains to patient well-being. AIMS OF THE STUDY: The scope of this review was to examine studies published in the international literature to describe and compare the social costs of depression in various countries. METHODS: A bibliographic search was performed on international medical literature databases (Medline, Embase), where all studies published after 1970 were selected. Studies were carefully evaluated and only those that provided cost data were included in the comparative analysis; this latter phase was conducted using a newly developed evaluation chart. RESULTS: 10 abstracts were firstly selected; 46 of them underwent a subsequent full paper reading, thus providing seven papers, which were the subject of the in-depth comparative analysis: three studies investigated the cost of depression in the USA, three studies in the UK and one study was related to Italy. All the studies examined highlight the relevant economic burden of depression; in 1990, including both direct and indirect costs, it accounted for US$ 43.7 billion in the US (US$ 65 billion, at 1998 prices) according to Greenberg and colleagues, whilst direct costs accounted for £417 million in the UK (or US$ 962.5 million, at 1998 prices), according to Kind and Sorensen. Within direct costs, the major cost driver was indeed hospitalization, which represented something in between 43 and 75% of the average per patient cost; conversely, drug cost accounted for only 2% to 11% in five out of seven studies. DISCUSSION: Indeed, our review suggests that at the direct cost level, in both the United States and the United Kingdom, the burden of depression is remarkable, and this is confirmed by a recent report issued by the Pharmaceutical Research and Manufacturers Association (PhRMA) where prevalence and cost of disease were compared for several major chronic diseases, including Alzheimer, asthma, cancer, depression, osteoporosis, hypertension, schizophrenia and others: in this comparison, depression is one of the most significant diseases, ranked third by prevalence and sixth in terms of economic burden. Moreover, in terms of the average cost per patient, depression imposes a societal burden that is larger than other chronic conditions such as hypertension, rheumatoid arthritis, asthma and osteoporosis. The application of economic methods to the epidemiological and clinical field is a relatively recent development, as evidenced by the finding that, out of the seven studies examined, three refer to the US environment, three to the UK and one to Italy, while nothing was available about the cost of depression for large countries suc
{"title":"Depression: cost-of-illness studies in the international literature, a review","authors":"Patrizia Berto, Daniele D'Ilario, Pierfrancesco Ruffo, Roberto Di Virgilio, Fortunato Rizzo","doi":"10.1002/1099-176X(200003)3:1<3::AID-MHP68>3.0.CO;2-H","DOIUrl":"https://doi.org/10.1002/1099-176X(200003)3:1<3::AID-MHP68>3.0.CO;2-H","url":null,"abstract":"BACKGROUND: Depression is one of the most ancient and common diseases of the human race and its burden on society is really impressive. This stems both from the epidemiological spread (lifetime prevalence rate, up to 30 years of age, was estimated as greater than 14.4% by Angst et al.) and from the economic burden on healthcare systems and society, but also as it pertains to patient well-being. AIMS OF THE STUDY: The scope of this review was to examine studies published in the international literature to describe and compare the social costs of depression in various countries. METHODS: A bibliographic search was performed on international medical literature databases (Medline, Embase), where all studies published after 1970 were selected. Studies were carefully evaluated and only those that provided cost data were included in the comparative analysis; this latter phase was conducted using a newly developed evaluation chart. RESULTS: 10 abstracts were firstly selected; 46 of them underwent a subsequent full paper reading, thus providing seven papers, which were the subject of the in-depth comparative analysis: three studies investigated the cost of depression in the USA, three studies in the UK and one study was related to Italy. All the studies examined highlight the relevant economic burden of depression; in 1990, including both direct and indirect costs, it accounted for US$ 43.7 billion in the US (US$ 65 billion, at 1998 prices) according to Greenberg and colleagues, whilst direct costs accounted for £417 million in the UK (or US$ 962.5 million, at 1998 prices), according to Kind and Sorensen. Within direct costs, the major cost driver was indeed hospitalization, which represented something in between 43 and 75% of the average per patient cost; conversely, drug cost accounted for only 2% to 11% in five out of seven studies. DISCUSSION: Indeed, our review suggests that at the direct cost level, in both the United States and the United Kingdom, the burden of depression is remarkable, and this is confirmed by a recent report issued by the Pharmaceutical Research and Manufacturers Association (PhRMA) where prevalence and cost of disease were compared for several major chronic diseases, including Alzheimer, asthma, cancer, depression, osteoporosis, hypertension, schizophrenia and others: in this comparison, depression is one of the most significant diseases, ranked third by prevalence and sixth in terms of economic burden. Moreover, in terms of the average cost per patient, depression imposes a societal burden that is larger than other chronic conditions such as hypertension, rheumatoid arthritis, asthma and osteoporosis. The application of economic methods to the epidemiological and clinical field is a relatively recent development, as evidenced by the finding that, out of the seven studies examined, three refer to the US environment, three to the UK and one to Italy, while nothing was available about the cost of depression for large countries suc","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 1","pages":"3-10"},"PeriodicalIF":1.6,"publicationDate":"2000-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200003)3:1<3::AID-MHP68>3.0.CO;2-H","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72190168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-19DOI: 10.1002/1099-176X(200003)3:1<35::AID-MHP69>3.0.CO;2-I
Douglas L. Leslie, Robert Rosenheck, William D. White
<div> <section> <h3> Background:</h3> <p>Both private and public health care systems have embraced capitated reimbursement as a method of controlling costs.</p> </section> <section> <h3> Aims of the Study:</h3> <p>This study explores the financial implications of using reimbursement models based on clinically based patient classification schemes to distribute funds for the treatment of mental health patients in the Department of Veterans Affairs (VA).</p> </section> <section> <h3> Methods:</h3> <p>We identified 53700 veterans treated in VA specialty mental health outpatient clinics during the first 2 weeks of fiscal year (FY) 1991 for whom relevant clinical data were available. We calculated total utilization and costs for this sample during the remainder of FY 1991 using VA administrative databases and simulated hypothetical distributions of funds based on seven alternative capitation models. The resulting distributions of funds across service networks and facility types were compared to actual expenditures.</p> </section> <section> <h3> Results:</h3> <p>Approximately 8% of overall VA budget was redistributed under a simple capitated scheme, and some individual networks and facility types experienced changes in funding of over 30%. Models based on clinical data resulted in only minor differences from average-cost reimbursement. Substantial variation in practice style was observed across Veterans Integrated Service Networks (VISNs), which was significantly associated with funding shifts under capitation.</p> </section> <section> <h3> Discussion:</h3> <p>A simple capitated payment scheme would result in large changes in funding for some VISNs. Adjustments for case mix did not substantially affect patterns of redistribution. Patterns of redistribution appear to reflect large differences in practice style across VISNs. Although a capitated system will create incentives to reduce such variation, the effect of such shifts on patient well-being is unknown.</p> </section> <section> <h3> Implications for Health Policies:</h3> <p>Any capitated system will create incentives to provide a uniform standard of care. In our analyses, the capitation rate was based on the average cost per treated patient in each category; however rates could be set higher or lower as policy makers deem necessary. The standard of care associated with the average cost is not necessarily the ‘correct’ level of care.</p> </section> <section> <h
{"title":"Capitated payments for mental health patients: a comparison of potential approaches in a public sector population","authors":"Douglas L. Leslie, Robert Rosenheck, William D. White","doi":"10.1002/1099-176X(200003)3:1<35::AID-MHP69>3.0.CO;2-I","DOIUrl":"https://doi.org/10.1002/1099-176X(200003)3:1<35::AID-MHP69>3.0.CO;2-I","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background:</h3>\u0000 \u0000 <p>Both private and public health care systems have embraced capitated reimbursement as a method of controlling costs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims of the Study:</h3>\u0000 \u0000 <p>This study explores the financial implications of using reimbursement models based on clinically based patient classification schemes to distribute funds for the treatment of mental health patients in the Department of Veterans Affairs (VA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods:</h3>\u0000 \u0000 <p>We identified 53700 veterans treated in VA specialty mental health outpatient clinics during the first 2 weeks of fiscal year (FY) 1991 for whom relevant clinical data were available. We calculated total utilization and costs for this sample during the remainder of FY 1991 using VA administrative databases and simulated hypothetical distributions of funds based on seven alternative capitation models. The resulting distributions of funds across service networks and facility types were compared to actual expenditures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>Approximately 8% of overall VA budget was redistributed under a simple capitated scheme, and some individual networks and facility types experienced changes in funding of over 30%. Models based on clinical data resulted in only minor differences from average-cost reimbursement. Substantial variation in practice style was observed across Veterans Integrated Service Networks (VISNs), which was significantly associated with funding shifts under capitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion:</h3>\u0000 \u0000 <p>A simple capitated payment scheme would result in large changes in funding for some VISNs. Adjustments for case mix did not substantially affect patterns of redistribution. Patterns of redistribution appear to reflect large differences in practice style across VISNs. Although a capitated system will create incentives to reduce such variation, the effect of such shifts on patient well-being is unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Implications for Health Policies:</h3>\u0000 \u0000 <p>Any capitated system will create incentives to provide a uniform standard of care. In our analyses, the capitation rate was based on the average cost per treated patient in each category; however rates could be set higher or lower as policy makers deem necessary. The standard of care associated with the average cost is not necessarily the ‘correct’ level of care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 1","pages":"35-44"},"PeriodicalIF":1.6,"publicationDate":"2000-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200003)3:1<35::AID-MHP69>3.0.CO;2-I","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72157721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2000-07-19DOI: 10.1002/1099-176X(200003)3:1<56::AID-MHP82>3.0.CO;2-U
Ella Rytik
Please see the PDF file for the abstracts translations in Russian.
请参阅PDF文件中的摘要俄语翻译。
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Pub Date : 2000-07-19DOI: 10.1002/1099-176X(200003)3:1<45::AID-MHP71>3.0.CO;2-1
Per Bernhard Pedersen, Solfrid Lilleeng
<div> <section> <h3> Background:</h3> <p>During the last decades, a central aim of Norwegian health policy has been to achieve a more equal geographical distribution of services. Of special interest is the 1980 financial reform. Central government reimbursements for the treatment of in-patients were replaced by a block grant to each county, based on indicators of relative ‘need’.</p> </section> <section> <h3> Aims of the study:</h3> <p>The aim of this paper is to assess whether the distribution of specialized mental health services did take the course suggested by the proponents of the reform (i.e. a more equal distribution), or the opposite (i.e. a more unequal distribution) as claimed by the opponents.</p> </section> <section> <h3> Methods:</h3> <p>Man year <i>per capita</i> ratios were used as indicators for the distribution of mental health services by county. Ratios were estimated for ‘all personnel’, and for MDs and psychologists separately. Man years were assigned to counties by <i>location</i> of services (i.e. in which county the services were produced), and by <i>residence</i> of users (i.e. in which county the services were consumed). Indicators of geographic variation were estimated using the standard deviation (STD) as a measure of <i>absolute variation</i>, and the coefficient of variation (CV) and the Gini index as indicators of <i>relative variation</i>. Indicators were estimated for 1979, 1984, 1989 and 1994, based on data for all specialized adult mental health services in the country. Changes in distributions over the period were tested, using Levene's test of homogeneity.</p> </section> <section> <h3> Results:</h3> <p>Relative variations in the distribution of personnel by <i>location of services</i> were substantially reduced over the period, the CV being reduced by more than 50% for all groups. Variations in the personnel ratios by <i>residence of users</i> were smaller at the start of the period, and the reductions were also smaller. Still, relative variations were reduced by 20–35, 40 and 60% approximately for ‘all personnel’, MDs and psychologists respectively. In spite of a major increase in the supply of MDs and psychologists, <i>absolute</i> variations in the personnel ratios were in all cases either reduced, or fairly stable.</p> <p>These results give little support to the views expressed by the opponents of the 1980 reform, although the main result seems to have been relocations in the <i>production of services</i>, more than re-distributions in the <i>consumption of services</i>.</p> </section> <section> <h3> D
{"title":"Resource distribution in mental health services: changes in geographic location and use of personnel in Norwegian mental health services 1979–1994","authors":"Per Bernhard Pedersen, Solfrid Lilleeng","doi":"10.1002/1099-176X(200003)3:1<45::AID-MHP71>3.0.CO;2-1","DOIUrl":"https://doi.org/10.1002/1099-176X(200003)3:1<45::AID-MHP71>3.0.CO;2-1","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background:</h3>\u0000 \u0000 <p>During the last decades, a central aim of Norwegian health policy has been to achieve a more equal geographical distribution of services. Of special interest is the 1980 financial reform. Central government reimbursements for the treatment of in-patients were replaced by a block grant to each county, based on indicators of relative ‘need’.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims of the study:</h3>\u0000 \u0000 <p>The aim of this paper is to assess whether the distribution of specialized mental health services did take the course suggested by the proponents of the reform (i.e. a more equal distribution), or the opposite (i.e. a more unequal distribution) as claimed by the opponents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods:</h3>\u0000 \u0000 <p>Man year <i>per capita</i> ratios were used as indicators for the distribution of mental health services by county. Ratios were estimated for ‘all personnel’, and for MDs and psychologists separately. Man years were assigned to counties by <i>location</i> of services (i.e. in which county the services were produced), and by <i>residence</i> of users (i.e. in which county the services were consumed). Indicators of geographic variation were estimated using the standard deviation (STD) as a measure of <i>absolute variation</i>, and the coefficient of variation (CV) and the Gini index as indicators of <i>relative variation</i>. Indicators were estimated for 1979, 1984, 1989 and 1994, based on data for all specialized adult mental health services in the country. Changes in distributions over the period were tested, using Levene's test of homogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results:</h3>\u0000 \u0000 <p>Relative variations in the distribution of personnel by <i>location of services</i> were substantially reduced over the period, the CV being reduced by more than 50% for all groups. Variations in the personnel ratios by <i>residence of users</i> were smaller at the start of the period, and the reductions were also smaller. Still, relative variations were reduced by 20–35, 40 and 60% approximately for ‘all personnel’, MDs and psychologists respectively. In spite of a major increase in the supply of MDs and psychologists, <i>absolute</i> variations in the personnel ratios were in all cases either reduced, or fairly stable.</p>\u0000 \u0000 <p>These results give little support to the views expressed by the opponents of the 1980 reform, although the main result seems to have been relocations in the <i>production of services</i>, more than re-distributions in the <i>consumption of services</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> D","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 1","pages":"45-53"},"PeriodicalIF":1.6,"publicationDate":"2000-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200003)3:1<45::AID-MHP71>3.0.CO;2-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72190170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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