Australia's mental health care system. Struggle to cope with demand. But more cash won't mean everyone gets the care they need.
As we outline in Do this week's researchwe'd like to incentivize health providers to enhance outcomes reasonably than pay them to do more.
This research was funded by the Australian Government National Mental Health CommissionOutline why such reform is required and the way it would work.
Mental health care problem
Many Australians with mental unwell health cannot access the care they need due to long waiting lists and high patient costs.
About two-thirds of patients are waiting. More than 12 weeks To maintain their mental disorders. One in five people reported. Costs There was a reason for delaying or not seeing a mental health skilled.
Even when people do access care, it is usually not evidence-based, reducing the possibilities of early recovery. For example, approx Half of all competitions Treating depression is taken into account inappropriate and consequently undervalued.
There are also gaps in individualized care pathways. For example, some people who find themselves hospitalized after a suicide attempt may not receive mental health care after they leave. People have difficulty navigating mental health care services inside the community, which implies people can fall through the cracks and never get the care they need.
This results ill outcomes and the use of high-priced acute inpatient care as a substitute of inexpensive community-based care, wasting useful health care system resources.
How can we alter things?
One reason mental health care struggles to fulfill patient needs is due to how health care is financed. Medicare pays providers fees for his or her services based on the Medicare Benefits Schedule (MBS).
MBS incentivizes providers to supply more services because providers are paid based on each service they supply. This fee-for-service model doesn't incentivize providers to supply good quality care, or effectively improve health outcomes.
So we'd like to reform how mental health care is financed, including paying for excellent care that delivers meaningful patient outcomes.
All Australian governments have. Agreed on health care reform.Including beginning to pay for price and results.
Implementation has begun but is slower than expected. The government also desires to shift GP funding to payment models that mix Medicare with other types of payment, comparable to value-based payments.
How can we pay for good value care?
Our research explored methods to add more value to mental health care financing using value-based payments.
We interviewed state, territory and federal government departments and agencies, and held several national workshops with providers, care recipients, carers, higher education institutions and academics.
Under a value-based payment model, doctors, psychiatrists and psychologists locally would receive more funding in the event that they provided higher care. We cannot rule out that some individuals are receiving less money for not hitting agreed targets, which could also be controversial.
These financial incentives will seek to incentivize providers to take a position their effort and time in improving their care, expertise and patient experience.
Measured outcomes will probably be valued by patients, comparable to more competent social interactions and increased ability to operate at work. This would require a shift in providers' pondering, which primarily seeks to enhance clinical outcomes. Our advice suggested that clinical outcomes don't all the time align with patient value.
Incentives could be targeted at individual practitioners, multidisciplinary teams or mixtures apart from practices. Value-based payments can integrate different health services to concentrate on patient needs and preferences. This may include physical and mental health services which can be bundled right into a package of care, as one normally brings concerning the other.
Value-based payments may also be used to link mental health services with non-health services that affect mental health outcomes, comparable to social care, housing, education and justice services. These bundles of care aim to treat the patient in addition to address the underlying causes of poor mental health.
How can we know it'll work?
There was consensus amongst our respondents to make use of value-based payment models within the Australian mental health care system. Unfortunately, there may be little evidence on methods to best structure it.
Emerging evidence This shows that there are advantages to paying providers more for providing higher quality care than using a fee-for-service model. However, some trials have did not improve outcomes.
Our research suggests that we'd like to learn more concerning the size of incentives and whether or not they should goal individual practitioners, teams or practices, what outcomes we should always measure, and what goals providers should aim to realize. Should try.
This evidence can only be gathered through randomized controlled trials conducted within the Australian healthcare system, applied over time and in numerous settings. We have to learn from the successes and failures of those trials.
Overcoming obstacles
Reforming mental health care funding for value-based payments will probably be complex and difficult.
Our respondents identified barriers, including:
- Defining vital outcomes for patients
- Overcoming the dearth of evidence on how value-based payments can improve outcomes.
- Bridging the manpower gap
- Navigating political complexities and methodological challenges
- To meet the associated fee of reforms.
Providers might want to change their business models, and government will need to take a position heavily in data collection and data infrastructure.
What must occur next?
Government needs to raised define what value means in mental health care and establish an agreed set of agreed outcomes. It needs to boost awareness amongst providers about why value-based payments are needed and develop a ten-year strategy and implementation plan.
Over the following 4 years, the federal government should develop and implement a mental health data infrastructure technique to help close the info gap. Mental health care funding reforms must be integrated into ongoing payment reforms in hospitals and first care.
There must also be more accountability for reforms. An independent value-based payment authority must be created to work with state, territory and federal governments to design, coordinate and evaluate recent value-based payment models.
Using financial incentives to alter provider behavior won't fix Australia. The mental health care crisis Alone, but the federal government cannot solve this crisis without reforming how we motivate and pay for care that improves mental health.