Description
Reassessing the Portuguese mental health system: evaluating its performance, and designing a new financial and organizational model aimed at enhancing its equity, efficiency, and quality. The National Plan for the Restructuring of Mental Health Services mentions an insufficient access to care, a lack of prevention, an excessive focus on in-patient admissions, and an insufficient coordination between providers. This project aims at (i) evaluating the performance of the Portuguese mental health system; (ii) proposing an innovative model of management and financing of health care providers; (iii) designing a financing scheme for mental health care. The project will be conducted using qualitative methods (systematic literature reviews and semi-structured interviews), and quantitative methods (a theoretical microeconomic model and a prospective study of patients’ costs). The project is expected to particularly benefit underprivileged patients facing greater difficulties to access care and in managing their disease across providers. Its international character and partnership will be crucial for its success, since it is centered on comparing mental health systems.
Summary of project results
The Portuguese mental Health system has been scrutinized in detail in the National Mental Health Plan 2007 – 2016, published in 2008. This Plan mentions an insufficient access to care, a lack of prevention, an excessive focus on in-patient admissions, and an insufficient coordination between providers. These weaknesses are worrisome in a context of increasing burden of mental Health, once, in Portugal, mental Health disorders account for 11.7% of disease-adjusted life years (DALYs), being the second cause of DALYs. The IP: mental health project showed how the Portuguese mental health system was failing to achieve these topics, despite well-designed and consensual mental health plans. This project postulated that these failures are mainly explained by the incapacity to in the implementation of reforms, based on adequate payment of mental healthcare providers - if providers are not adequately reimbursed, they are not incentivized to implement the evidence-based practices. Finally, this project designed an alternative financing model for mental healthcare providers in Portugal, using economic tools to address the crucial public health issue of mental health. In the elaboration of this innovative financing model for the Portuguese mental health, this project also considered the improved the capacity of primary care to treat depression, the development of prevention and mental health promotion in children and adolescents, and the evaluation of mental health problems at all ages (until 18) by family doctors. The objectives of the project were achieved through of the following outputs: 1 submitted paper in national journal, 1 submitted paper in international journal, 4 presentations in international meetings, 4 presentations in national meetings, 1 final report and 1 final workshop. The results of the project contributed to the goal of the sub-area “Mental Health financing system improved”. Indeed, the innovative payment model which was designed has prompted a strong attention from mental health specialists, reflected in the many comments and invitations to present this mode in various settings/cities, and in demands to participate in other projects. Also, the model was supported by the Adjunct and Health Secretary of State, following which its implementation is currently being prepared in collaboration with the Central Administration of the Health System (ACSS).
Summary of bilateral results
The three international partners have been involved in the two stages of the careful revision and evaluation of the current payment scheme, and in the evaluation of the proposal of an innovative payment scheme, performed by three well-recognized specialists in the mental health área: Vincent Lorant (Université Catholique de Louvain), Francesco Amaddeo (University of Verona) and Jan Tvedt (Norwegian General Health Directorate).