Reforming the Portuguese mental health system

Detalhes bibliográficos
Autor(a) principal: Perelman, Julian
Data de Publicação: 2018
Outros Autores: Chaves, Pedro, de Almeida, José Miguel Caldas, Matias, Maria Ana
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: https://doi.org/10.1186/s13033-018-0204-4
Resumo: Funding agency: Norway, Iceland (grant nr.00065SM1), Liechtenstein, through the EEA grants and ACSS
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network_name_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
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spelling Reforming the Portuguese mental health systeman incentive-based approachAccessInnovative paymentMental healthPrimary carePhychiatric Mental HealthHealth PolicyPublic Health, Environmental and Occupational HealthPsychiatry and Mental healthSDG 3 - Good Health and Well-beingFunding agency: Norway, Iceland (grant nr.00065SM1), Liechtenstein, through the EEA grants and ACSSBackground: 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.Escola Nacional de Saúde Pública (ENSP)NOVA School of Business and Economics (NOVA SBE)RUNPerelman, JulianChaves, Pedrode Almeida, José Miguel CaldasMatias, Maria Ana2018-07-16T22:09:56Z2018-05-302018-05-30T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://doi.org/10.1186/s13033-018-0204-4eng1752-4458PURE: 4353704http://www.scopus.com/inward/record.url?scp=85047923888&partnerID=8YFLogxKhttps://doi.org/10.1186/s13033-018-0204-4info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2024-03-11T04:22:25Zoai:run.unl.pt:10362/41782Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T03:31:23.326102Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Reforming the Portuguese mental health system
an incentive-based approach
title Reforming the Portuguese mental health system
spellingShingle Reforming the Portuguese mental health system
Perelman, Julian
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
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
author Perelman, Julian
author_facet Perelman, Julian
Chaves, Pedro
de Almeida, José Miguel Caldas
Matias, Maria Ana
author_role author
author2 Chaves, Pedro
de Almeida, José Miguel Caldas
Matias, Maria Ana
author2_role author
author
author
dc.contributor.none.fl_str_mv Escola Nacional de Saúde Pública (ENSP)
NOVA School of Business and Economics (NOVA SBE)
RUN
dc.contributor.author.fl_str_mv Perelman, Julian
Chaves, Pedro
de Almeida, José Miguel Caldas
Matias, Maria Ana
dc.subject.por.fl_str_mv 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
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
description Funding agency: Norway, Iceland (grant nr.00065SM1), Liechtenstein, through the EEA grants and ACSS
publishDate 2018
dc.date.none.fl_str_mv 2018-07-16T22:09:56Z
2018-05-30
2018-05-30T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://doi.org/10.1186/s13033-018-0204-4
url https://doi.org/10.1186/s13033-018-0204-4
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 1752-4458
PURE: 4353704
http://www.scopus.com/inward/record.url?scp=85047923888&partnerID=8YFLogxK
https://doi.org/10.1186/s13033-018-0204-4
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
repository.mail.fl_str_mv
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