Bigelow D A, McFarland B H
Department of Psychiatry, School of Medicine (GH), Oregon Health Sciences University, Portland 97201.
Hosp Community Psychiatry. 1989 Aug;40(8):805-8. doi: 10.1176/ps.40.8.805.
In attempts to contain mental health costs, administrators are increasingly using incentives, competition, and accounting strategies and are creating more complicated financing systems. Yet the costs of these strategies and their impacts on the efficacy and efficiency of mental health services have yet to be studied. The authors compare mental health payment systems in British Columbia and Oregon. In the Canadian system, the patient is isolated from payment, sources of revenue are consolidated at the provincial level, only one payment mechanism per service type is used, health care documentation is oriented more to clinical needs than to reimbursement, and more discretion is delegated to providers. As a result, Canadian overhead costs are substantially less than those in the U.S. Patients have universal access to medical services in the Canadian system, and providers in hospitals, agencies, and individual practices have high incomes with low overhead costs.
为了控制心理健康成本，管理人员越来越多地采用激励措施、竞争手段和会计策略，并建立更为复杂的融资体系。然而，这些策略的成本及其对心理健康服务效果和效率的影响尚未得到研究。作者比较了不列颠哥伦比亚省和俄勒冈州的心理健康支付系统。在加拿大的系统中，患者与支付环节相分离，收入来源在省级层面进行整合，每种服务类型仅使用一种支付机制，医疗保健文件更侧重于临床需求而非报销，并且给予提供者更多的自主权。结果，加拿大的间接费用大幅低于美国。在加拿大的系统中，患者能够普遍获得医疗服务，医院、机构和个体诊所的提供者收入高且间接费用低。
