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Geographical resource allocation for public mental health services in Victoria.

OBJECTIVE: To provide background information on the approach of area based funding models for mental health services, to describe the considerations which have come to bear in the development process of the Victorian model, to explore the impacts of different models, and to suggest courses for further development. METHOD: The history of this approach to funding in the UK and the USA is summarised, then an account is given of the development of the Victorian model. The position is put that the validation of such models is hampered by having only sparse relevant data. Suggestions are made for improving this situation. RESULTS: The Victorian model has come to include adjustments for socioeconomic disadvantage, the age, sex and marital status structure of the population, and a variable discounting for estimated substitutive activity of the private sector. Different methods of combining these adjustments into a working formula can be seen to have very different impacts. CONCLUSIONS: The approach taken in development of this model can be expected to have major influence on funding within Victoria, but also more widely in Australia. The impacts of differing assumptions within these models are significant. Specifically targeted epidemiological research, and activity analysis of the private sector will be necessary to enhance the validity of models of this type.

Adolescent↗

Collaborative production and resource allocation: the consequences of prospective payment for hospital care.

This article presents a model of the intensity of care provided by hospitals and physicians and how such intensity was affected by the change to prospective payment by Medicare. Prospective payment introduced an incentive for hospitals to shorten average length of stay, but in order to keep the patient recovery level constant, intensity of inpatient care was forced to increase. Physicians reacted to hospital changes by increasing their own intensity of care provided to inpatients. Implications of the model for admissions and physician office time are also explored. Empirical results indicate that for the period 1983-1987, spanning the introduction of PPS, both hospital and physician intensity of care per inpatient rose significantly.

Evaluation Studies as Topic↗