| Abstract: |
The use of casemix-based funding mechanisms is increasing internationally.
This funding approach potentially offers incentives for a range of diverse
objectives, including improvements in efficiency, quality of care and patient
choice. However, to date, the application of this approach to mental health
care has been limited and there is no long-term experience to inform policy
and practice. In England, the Department of Health plans to extend the scope
of Payment by Results, an activitybased funding approach, to mental health.
The Care Pathways and Packages Clusters comprise a set of 21 ‘care clusters’
that together form ‘currencies’, or units for contracting and commissioning
mental health services. Each cluster defines a package of care for a group of
service users who are relatively similar in their care needs and therefore
resource requirements. At the time of writing, the currencies are being
refined and tested at several sites in England. In addition, costing exercises
are underway to investigate the resource implications of the currencies. The
intention is that from April 2010 these currencies can be used for
commissioning and benchmarking, using local prices agreed between
commissioners and providers. Options for moving to a national tariff will also
be explored, although its feasibility is unclear. The University of York was
asked by the Department of Health to assess the Care Pathways and Packages
Clusters from an economic perspective. This report examines the international
literature on payment mechanisms for mental healthcare services. These
approaches are described and critiqued, drawing on relevant theoretical and
empirical research to explore the strengths and weaknesses of payment
mechanisms. Implications for the proposed Care Pathways and Packages Clusters
are explored and recommendations are outlined. |