Nicaise Pablo, Dubois Vincent, Lorant Vincent
Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
Health Policy. 2014 Apr;115(2-3):120-7. doi: 10.1016/j.healthpol.2014.02.007. Epub 2014 Feb 14.
Most mental health care delivery systems in welfare states currently face two major issues: deinstitutionalisation and fragmentation of care. Belgium is in the process of reforming its mental health care delivery system with the aim of simultaneously strengthening community care and improving integration of care. The new policy model attempts to strike a balance between hospitals and community services, and is based on networks of services. We carried out a content analysis of the policy blueprint for the reform and performed an ex-ante evaluation of its plan of operation, based on the current knowledge of mental health service networks. When we examined the policy's multiple aims, intermediate goals, suggested tools, and their articulation, we found that it was unclear how the new policy could achieve its goals. Indeed, deinstitutionalisation and integration of care require different network structures, and different modes of governance. Furthermore, most of the mechanisms contained within the new policy were not sufficiently detailed. Consequently, three major threats to the effectiveness of the reform were identified. These were: issues concerning the relationship between network structure and purpose, the continued influence of hospitals despite the goal of deinstitutionalisation, and the heterogeneity in the actual implementation of the new policy.
目前,福利国家的大多数精神卫生保健服务体系面临两个主要问题:去机构化和护理碎片化。比利时正在改革其精神卫生保健服务体系,目的是同时加强社区护理并改善护理的整合。新的政策模式试图在医院和社区服务之间取得平衡,并以服务网络为基础。我们对改革的政策蓝图进行了内容分析,并根据目前对精神卫生服务网络的了解,对其运营计划进行了事前评估。当我们审视该政策的多重目标、中间目标、建议的工具及其衔接时,发现尚不清楚新政策如何能够实现其目标。事实上,去机构化和护理整合需要不同的网络结构和不同的治理模式。此外,新政策中包含的大多数机制不够详细。因此,确定了改革有效性面临的三大威胁。这些威胁是:网络结构与目的之间的关系问题、尽管有去机构化目标但医院的持续影响,以及新政策实际实施中的异质性。