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PubMed2006

Distributional impacts of mental health care financing arrangements: a comparison of the UK, Germany and Austria.

BACKGROUND: Although mental health care has undergone substantial re-structuring processes, little attention has been paid to financing issues during these processes. AIMS OF THE STUDY: In this paper the authors seek to examine distributional effects of systems of mental health care financing in the UK, Germany and Austria against the backdrop of ongoing reforms and broader welfare state transformations. METHOD: The article is based on secondary data on mental health care reform processes and financing arrangements. Distributional issues are studied a) on the macro-level related to the sectors 'state', 'market', 'family' and 'voluntary/community' and b) on the individual level. RESULTS AND DISCUSSION: In all of the three countries, shifts towards community care have resulted in a new division of financing responsibilities with a tendency to rising responsibilities for the 'family' and the 'voluntary/community sector'. In addition, strengthening market principles often increases financial burdens for affected individuals and/or their relatives. The study has been limited by the lack of precise data on resource allocation and expenditure for mental health care. IMPLICATIONS FOR HEALTH POLICIES, HEALTH CARE PROVISION AND USE: An increasing focus on the relationship between financing and service provision is required in order to prevent new forms of social exclusion of people with mental disorders. IMPLICATIONS FOR FURTHER RESEARCH: Further research needs to be carried out to increase transparency concerning the complex relationship between provision and the finance of mental health care. In terms of distributional impacts, it needs to be analysed in more detail which persons are affected in which ways. This particularly includes users as well as carers in the formal and informal sector.

Austria↗
PubMedDate not supplied

Experiences in paying for health care in India's voluntary sector.

This article summarizes the results of four in-depth case studies on the financing and costs of the health care programmes of well-known non-government organizations (NGOs) in India. These organizations have shown a high degree of creativity and innovation in developing varied sources of financing to reduce dependency and enable them to sustain their programmes. Government funds play a major role in supporting these voluntary health activities, with less significant roles played by foreign donations, user charges, pre-paid memberships, and public fund raising. Some effective methods of assuring access for poor clients while developing self financing are described. Cost studies of the NGOs' health schemes indicate that they operate at least as efficiently as public services and primarily supplement rather than substitute for such services. Suggestions for further development of voluntary sector financing are put forward.

Community Health Planning↗
PubMedDate not supplied

[The situation in integrated and community-oriented psychiatric treatment institutions with new financial realities].

The author describes the structure and functioning of a psychiatric treatment institution which is integrated and community-oriented. He discusses subsequently its readiness to implement changes and goes through adaptation actions (which have taken place at the cost of stuff and quality and extent of service). The situation after four months of financing by health-care funds has been analysed. Finally, the author presents his remarks regarding the on going changes, concerns for the future and suggests new solutions (e.g., capitalized way of financing psychiatric treatment institutions).

Community Mental Health Services↗
PubMed1984

Federal financing of dental services.

Federal support of health services delivery has been closely tied to social welfare and economic assistance legislation. Its underlying premise has been that health services should be provided by government only when individuals and families are unable to cope with health problems on their own. Dental care has never drawn a major share of health and welfare resources. It has been authorized in general terms by various statutes, but seldom have funds been earmarked specifically for dental services. Accordingly, the history of federal financing of dental services shows a gradual but progressive extension of services to populations and communities unable to obtain services on their own. Over time, a system of federal grants-in-aid has been built through which assistance is provided to state agencies or directly to communities or individuals. Table 3 provides a summary of the major programs. Before 1965, states received little federal support for dental services, except for funds provided through maternal and child health or crippled children's programs. Although Social Security authorized other public assistance funds that could be used for dental services, these were used principally to provide health services for the elderly. The relatively slow growth of federal dental programs accelerated during the Johnson and Nixon administrations. The explosion of health legislation during these years significantly broadened the federal role in providing health services to individuals and communities. Medicaid, the OEO programs, the health planning acts, migrant health, Appalachian Regional Development, Model Cities, and other statutes had significant impact on the accessibility and availability of dental services in poor, disadvantaged, rural, and otherwise underserved communities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2006

Financing mental health services in low- and middle-income countries.

Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries undergoing transition there has been a decline in coverage. The paper explores the impact of health care financing arrangements on the efficient and equitable utilization of mental health services. Through a review of the literature and a number of country case studies, the paper examines the impact of financing mental health services from out-of-pocket payments, private health insurance, social health insurance and taxation. The implications for the development of financing systems in low- and middle-income countries are discussed. International evidence suggests that charging patients for mental health services results in levels of use which are below socially efficient levels as the benefits of the services are distributed according to ability to pay, resulting in inequitable access to care. Private health insurance poses three main problems for mental health service users: exclusion of mental health benefits, limited access to those without employment and refusal to insure pre-existing conditions. Social health insurance may offer protection to those with mental health problems. However, in many low- and middle-income countries, eligibility is based on contributions and limited to those in formal employment (therefore excluding many with mental health problems). Tax-funded systems provide universal coverage in theory. However, the quality and distribution of publicly financed health care services makes access difficult in practice, particularly for rural poor communities.

Developing Countries↗
PubMed1989

Multidisciplinary response of San Francisco General Hospital to the AIDS epidemic.

Acquired immunodeficiency syndrome (AIDS)-related services offered by San Francisco General Hospital (SFGH); programs to protect employees who are at occupational risk for infection with human immunodeficiency virus (HIV); and the legal, ethical, and economic implications of such infection are discussed. Support from public officials, health-care professionals, and the community has enabled SFGH to develop an extensive program of AIDS-related services. The program consumes 10% of SFGH's budget and was responsible for treating 1693 patients between January 1981 and June 1988. The hospital has two internationally recognized units dedicated to the care of AIDS patients. Many of the medical and support departments at SFGH contribute expertise directly; clinical and basic research are also conducted. Other services sponsored by the hospital include HIV testing and counseling; special training for physicians and nurses; assisting patients with finances, housing, and home care; emotional support; and community education. Expenses per patient are lower at SFGH than nationally because of contributions from the private and public sectors, but costs are not fully recovered. Hospital employees are protected by a body substance precautions program, a comprehensive needle-stick program, mandatory reporting and evaluation of all exposures, and enrollment in a study to document seroconversions. Confidentiality and compensation remain major concerns. San Francisco General Hospital has a model program of caring for patients with AIDS and protecting its workers, but the issue of compensating those employees who do become infected with HIV has not yet been resolved.

AIDS Serodiagnosis↗
PubMed2007

Public health expenditure and spatial interactions in a decentralized national health system.

One of the limitations of cross-country health expenditure analysis refers to the fact that the financing, the internal organization and political restraints of health care decision-making are country-specific and heterogeneous. Yet, a way through is to examine the influence of such effects in those countries that have undertaken decentralization processes. In such a setting, it is possible to examine potential expenditure spillovers across the geography of a country as well as the influence of the political ideology of regional incumbents and institutional factors on public health expenditure. This paper examines the determinants of public health expenditure within Spanish region-states (Autonomous Communities, ACs), most of them subject to similar financing structures although exhibiting significant heterogeneity as a result of the increasing decentralization, region-specific political factors along with different use of health care inputs, economic dimension and spatial interactions.

Health Expenditures↗
PubMed2005

Intimate partner violence: forms, consequences and preparedness to act as perceived by healthcare staff and district and community leaders in a rural district in northern Vietnam.

OBJECTIVES: A qualitative study was conducted among healthcare staff and district and community leaders in May and June 2002 to describe their perceptions of violence occurring between intimate partners. It focused on male violence towards females, and its forms, consequences and preparedness to act in a rural setting in Vietnam. METHODS: Twenty men and 20 women were strategically selected for focus group discussions and a phenomenographic approach was employed. FINDINGS: Violence was described not only as physical but also, primarily, as affecting women's mental health status. Mental violence was exemplified as verbally offending, ignoring or humiliating a woman. Sexual abuse was mentioned less frequently. IPV was considered to be a private matter, occurring in the home away from relatives, neighbours and the local community. Only very serious cases would seek health care. Divorce and deteriorating family finances were reported as serious consequences, not least for the children. Local reconciliation groups, comprised of trusted community members, played a role in mediating, while health professionals were found to be uninformed about prevalence rates and reluctant to intervene. CONCLUSIONS: Gender-based violence needs to receive attention from policy makers, and effective advocacy programmes are needed at all levels. In Vietnam, partner violence against women seems to be recognized at Government level. At community level, Women's Union staff and local reconciliation groups are prepared to act. However, the subject is surrounded by silence. We found that healthcare workers exhibited a lack of understanding of violence against women as a health problem in their own working environment.

Attitude↗