Sistema português de saúde mental: avaliação crítica do modelo de pagamento aos prestadores

Perelman, Julian; Chaves, Pedro; Gago, Joaquim; Leuschner, António; Lourenço, Alexandre; Mestre, Ricardo; Pisco, Luís; Paixão, Isabel; Carvalho, Ana; Almeida, José Miguel Barros Caldas de

doi:10.1159/000486052

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…According to Statista Research, Portugal invested, approximately, 136.2 million Euros in mental health hospitals in 2019 [ 3 ], however, 80% of the total expenses are due to hospitalizations and emergency consultations in mental health [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Mental Health Patient-Reported Outcomes and Experiences Assessment in Portugal

Coelho

Bienassis

Klazinga

et al. 2022

IJERPH

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Mental ill-health is increasingly recognized by policymakers for its significant human and economic toll. The main objective of this study is to capture patient-reported outcomes and experiences on mental health care in Portugal using methods developed for international benchmarking purposes, such as the OECD Patient-reported Indicators Surveys. The study included 397 participants, 247 (62.2%) women, divided into four age groups: ages 16–24 years, ages 25–44 years, ages 45–65 years, and ages 66 years or older. The data collection procedure and analysis followed the OECD PaRIS Mental Health Working Group 2021 protocol allowing subsequent comparability with data from other OECD member countries. Findings on the WHO-5 Well-Being Index showed that women manifest a lower score in well-being following mental health care services use. This finding may be, at least in part, explained by the study population (mental health services users), including individuals with clinical depression which is more frequently observed in women. In terms of the level of satisfaction with treatment (provided by nurses, doctors, phycologists, etc.) the response “Yes, definitely” varied from 67% of answers regarding “time spent by care providers”, 76.3% “involvement in decisions” to 79.7% regarding “clarity of explanations” and 84.4% regarding the item courtesy and respect. This study shows the feasibility of implementing and using patient-reported metrics (PROM and PREM) in mental health services in Portugal. The study results generate useful clinical information to help meet the expectations and needs of patients, contributing to a continuous improvement of mental health community services.

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Section: Introductionmentioning

confidence: 99%

Mental Health Patient-Reported Outcomes and Experiences Assessment in Portugal

Coelho

Bienassis

Klazinga

et al. 2022

IJERPH

View full text Add to dashboard Cite

show abstract

“…Several ambitious and evidence-based plans have been proposed over the last decades, but none of them has been able to convincingly tackle these issues. We documented, in a previous contribution [ 5 ], that this failure was partly due to the inadequate payment mechanisms of Portuguese MH care providers, which did not encourage best practices. Among these mechanisms we highlighted the volume-based hospital financing system, which does not encourage the continuity of care or community-based interventions; and the capitation-based model for PHC, which favors long lists and short consultations, completed by a pay-for-performance (P4P) scheme that does not include a single MH indicator.…”

Section: Introductionmentioning

confidence: 99%

Reforming the Portuguese mental health system: an incentive-based approach

Perelman

Chaves

Caldas-de-Almeida

et al. 2018

Int J Ment Health Syst

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BackgroundTo 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.MethodsWe 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.ResultsWe 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.ConclusionsThe 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.

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Sistema português de saúde mental: avaliação crítica do modelo de pagamento aos prestadores

Cited by 2 publications

References 5 publications

Mental Health Patient-Reported Outcomes and Experiences Assessment in Portugal

Mental Health Patient-Reported Outcomes and Experiences Assessment in Portugal

Reforming the Portuguese mental health system: an incentive-based approach

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