| Popis: |
Research masters Organisation of mental health care provided by hospitals can be done with concentration of services in a few units or with several hospitals providing them. The trade-o↵ to be made is between being closer to patients having several units of low volume activity each or benefiting from economies of scale to obtain better outcomes. We address here the magnitude of the scale e↵ects in mental health care. This provides important information to address the above-mentioned trade-o↵. We also analyse the importance of integrated continuous care services in mental health as a complement to inpatient care by computing the potential savings to the National Health Service (NHS). These services are a set of sequential interventions in mental health and/or social support, focusing on rehabilitation and recovery of patients with psychosocial disability. Analysing both economies of scale and integrated continuous care are relevant issues for mental health system financing. We use a diagnosis related group (DRG) dataset from 2001 to 2013 considering only mental health inpatient discharges, from an European country with a case-mix based funding system (Portugal). Using a conditional risk set model, we find a scale e↵ect for each DRG that ranges between 0 and 1 day. The magnitude of the scale e↵ect is not sufficiently high to justify the centralisation of psychiatric services in higher volume hospitals. We find potential savings for the NHS if integrated continuous care was in place. The focus of mental health system redesign should be on promoting integrated mental health care, with concentration of hospital services not being particularly relevant. |
