London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK.
Eur J Health Econ. 2018 Jun;19(5):709-718. doi: 10.1007/s10198-017-0915-5. Epub 2017 Jun 24.
Provider payment systems for mental health care that incentivize cost control and quality improvement have been a policy focus in a number of countries. In England, a new prospective provider payment system is being introduced to mental health that should encourage providers to control costs and improve outcomes. The aim of this research is to investigate the relationship between costs and outcomes to ascertain whether there is a trade-off between controlling costs and improving outcomes. The main data source is the Mental Health Minimum Data Set (MHMDS) for the years 2011/12 and 2012/13. Costs are calculated using NHS reference cost data while outcomes are measured using the Health of the Nation Outcome Scales (HoNOS). We estimate a bivariate multi-level model with costs and outcomes simultaneously. We calculate the correlation and plot the pairwise relationship between residual costs and outcomes at the provider level. After controlling for a range of demographic, need, social, and treatment variables, residual variation in costs and outcomes remains at the provider level. The correlation between residual costs and outcomes is negative, but very small, suggesting that cost-containment efforts by providers should not undermine outcome-improving efforts under the new payment system.
在许多国家，激励成本控制和质量改进的精神卫生保健提供者支付系统一直是政策重点。在英国，正在引入一种新的针对精神健康的前瞻性提供者支付系统，该系统应鼓励提供者控制成本并改善结果。本研究旨在调查成本与结果之间的关系，以确定在控制成本和改善结果之间是否存在权衡。主要数据来源是 2011/12 年和 2012/13 年的心理健康最低数据集 (MHMDS)。成本使用 NHS 参考成本数据计算，而结果使用国民健康结果量表 (HoNOS) 衡量。我们同时使用成本和结果估计了一个双变量多层次模型。我们计算了提供者层面上剩余成本和结果之间的相关性，并绘制了两者之间的两两关系图。在控制了一系列人口统计学、需求、社会和治疗变量后，成本和结果的剩余变化仍在提供者层面上。剩余成本和结果之间的相关性为负，但非常小，这表明提供者的成本控制努力不应在新的支付系统下破坏改善结果的努力。
