Centre for Health Economics, University of York, Heslington, York, UK.
J Ment Health. 2011 Jun;20(3):234-48. doi: 10.3109/09638237.2011.562261.
Activity-based funding mechanisms are widely used in acute care. In England, payment by results is being extended to mental health care, but its financial viability is unclear.
To identify international examples of activity-based funding systems for mental health care and to inform the development of a national tariff in England.
The international literature on payment systems for mental healthcare services was reviewed. Payment systems were appraised from an economic perspective. Variations in cost between English mental healthcare providers were explored using routine inpatient data on length of stay in 2007/8.
The review identified activity-based mental healthcare payment systems in five countries. International experience highlights the need for gradual and stepwise implementation; the use of budget neutrality adjustments; top-slicing of budgets to stabilise provider income; and use of the classification system to drive improvements in quality and cost-effectiveness. All systems adjusted for length of stay, but methods varied. Comparing English mental healthcare providers, median length of stay ranged from 2 to 42 days for emergency admissions and from 0 to 56 days for elective admissions.
New payment systems must account for the economic incentives they embody, and appropriate adjustments for variations in length of stay are essential.
基于活动的资金机制在急性护理中被广泛使用。在英国，按成果付费正在扩展到精神卫生保健领域，但它的财务可行性尚不清楚。
确定国际上用于精神卫生保健的基于活动的资金系统的范例，并为在英国制定国家关税提供信息。
综述了关于精神卫生保健服务支付系统的国际文献。从经济角度评估了支付系统。使用 2007/8 年住院时间的常规住院数据，探索了英国精神卫生保健提供者之间的成本差异。
综述确定了五个国家的基于活动的精神卫生保健支付系统。国际经验强调需要逐步和逐步实施；使用预算中性调整；将预算的一部分用于稳定提供者的收入；并使用分类系统来提高质量和成本效益。所有系统都对住院时间进行了调整，但方法不同。比较英国的精神卫生保健提供者，急症入院的平均住院时间从 2 天到 42 天不等，择期入院的平均住院时间从 0 天到 56 天不等。
新的支付系统必须考虑到其所体现的经济激励因素，并且适当调整住院时间的差异至关重要。
