Effects of Payment Mechanisms in Community Mental Health Centres in Chile: A Qualitative Analysis.

Abstract

Background In Chile, as in Latin America, the Mental Health Community Centre (CSMC) is essential to the new community care model. Chile's national mental health plan indicates that the payment mechanisms to the CSMC have been misaligned with the care model by encouraging an individual response to the detriment of an approach to recovery and social integration. Nevertheless, evidence needs to be available describing the effects of the payment mechanisms on CSMCs. The psychiatric deinstitutionalization reforms are subordinated to the financial structure of the health system that could introduce non-aligned incentives, which have yet to be studied. We want to understand better the effects of payment mechanisms on the operation of CSMCs in Chile. This research aims to have a knowledge base to interpret better how payment mechanisms are a potential incentive or disincentive for the community model of mental health. Methods Qualitative study using Grounded Theory. Through theoretical sampling, 25 experts were interviewed with informed consent. The inclusion criteria consider the experts representing the payer, provider, and users. Results The experts identified seven payment mechanisms for CSMCs in Chile. Its implementation is heterogeneous. Clinical achievements, proximity, coverage, and context of care are described. We identified fifteen adverse effects that contravene the objectives of the community model of mental health. We proposed elements to design payment mechanisms consistent with the community mental health model. Conclusions The payment mechanisms can act adversely on several components of the CSMC, contravening the objectives of the community mental health model. It is possible to identify a mix of better-articulated payment mechanisms by listening to the experience of those who pay for, provide, and use these services.