McDaid David, Samyshkin Yvevgeniy Aleksievich, Jenkins Rachel, Potasheva Angelina, Nikiforov Alexey, Ali Atun Rifat
LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
Health Policy. 2006 Dec;79(2-3):144-52. doi: 10.1016/j.healthpol.2005.12.014. Epub 2006 Feb 10.
To evaluate how the regulatory environment and health system organisation, financing and provider payment systems influence the delivery of mental health services in the Sverdlovsk region of the Russian Federation.
A multi-methods study was conducted including analysis of routine data and key informant interviews supplemented by analysis of published literature, legal and regulatory documents, ministerial orders and reports.
Mental health care services are still largely provided in hospitals, although the need for more community-based and rehabilitation services is widely recognised. Resource allocation and provider payment systems remain largely unchanged from Soviet times and favour large inpatient institutions, creating incentives for hospitals to maintain a large number of beds and staff. Community-based social services and human resources remain limited, especially in the areas of social work, housing support and vocational rehabilitation, but co-operation across sectors at local level is growing.
In Russia, the pace of reform in the mental health system will be helped if financial resource allocation mechanisms and provider payment systems are also reformed, so that resources follow individuals regardless of where they are treated. Such major health system shifts can only be achieved through changes at the Federal level and require major political will. Additional transitional funding is also required to help develop the necessary alternative community-based services. The nature of mental health disorders mean that this is not a problem faced within the health system alone, greater attention needs to be placed also on how to maximise the cross sector benefits especially with the social protection and employment sectors.
评估俄罗斯联邦斯维尔德洛夫斯克地区的监管环境、卫生系统组织、筹资及提供者支付系统如何影响精神卫生服务的提供。
开展了一项多方法研究，包括对常规数据的分析、关键信息提供者访谈，并辅以对已发表文献、法律法规文件、部委命令及报告的分析。
精神卫生保健服务仍主要在医院提供，尽管人们普遍认识到需要更多基于社区的康复服务。资源分配和提供者支付系统自苏联时期以来基本未变，且有利于大型住院机构，这促使医院维持大量床位和工作人员。基于社区的社会服务和人力资源仍然有限，尤其是在社会工作、住房支持和职业康复领域，但地方层面的跨部门合作正在增加。
在俄罗斯，如果财政资源分配机制和提供者支付系统也进行改革，使资源跟随个人，无论其接受治疗的地点在哪里，精神卫生系统的改革步伐将得到推动。这种重大的卫生系统转变只能通过联邦层面的变革来实现，需要重大的政治意愿。还需要额外的过渡性资金来帮助发展必要的替代性社区服务。精神障碍的性质意味着这不仅仅是卫生系统内部面临的问题，还需要更加关注如何最大限度地实现跨部门效益，特别是与社会保护和就业部门的效益。
