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Incentives in financing mental health care in Austria.
J Ment Health Policy Econ. 2002 Sep; 5(3):121-9.JM

Abstract

BACKGROUND

In Austria, financing health care -and even more so mental health care- is characterized by a mix of federal and provincial responsibilities, lack of uniformity in service provision and service providers, and diverse funding arrangements. The division between financing structures for health care and social care makes the situation even more complex. This state of affairs results in various, partly counterproductive and sometimes paradoxical financial incentives and disincentives for the providers, recipients and financiers of mental health services. In several provinces of Austria, recent reform plans in mental health care have focused strongly on establishing community-based and patient-oriented mental health care. One of the main challenges in implementing this new policy is the re-allocation of resources.

AIMS OF THE STUDY

The authors hypothesize that the existing structure of mental health care financing, with its incentives and disincentives, constitutes an obstacle to patient-oriented community-based mental health care. Analyzing the characteristics of the overall mental health care financing system in one Austrian province, Lower Austria, will provide a better understanding of actor-relationships and inherent incentives and highlight implications for the process of deinstitutionalization.

METHOD

The authors used an analytical framework based on the principal-agent theory, empirical evidence, and information on financial, organizational and legal structures to identify the characteristics of actor-relationships and the position of single actors within the system.

RESULTS

The article shows how incentives are linked to existing constellations of actors involved in mental health care financing and identifies significant power relations. As a consequence, incentives and disincentives within the financing system result in hospital- centered and supply-oriented mental health care in Lower Austria.

DISCUSSION

The current system of financing mental health care provides an obstacle to the provision of patient-oriented and community-based mental care. This is due to existing constellations and power relations among the actors where, most importantly, patients are the weakest party in the patient-payer-provider triangle. Balancing power relations will be a significant prerequisite for alternative financing systems. IMPLICATIONS FOR HEALTH POLICIES AND FURTHER RESEARCH: If a community and needs-based mental health care system is to be established in Austria, the financing structures have to be changed accordingly. Applying a principal-agent framework is useful for identifying key aspects in mental health care financing in relation to the provision of services. Further research is needed to help develop alternative financing mechanisms that support community-based and patient-oriented mental health care systems.

Authors+Show Affiliations

Department of Social Policy, Vienna University of Economics and Business Administration, Reithlegasse 16, A- 1190 Wien, Austria. ingrid.zechmeister@wu-wien.ac.atNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12728199

Citation

Zechmeister, Ingrid, et al. "Incentives in Financing Mental Health Care in Austria." The Journal of Mental Health Policy and Economics, vol. 5, no. 3, 2002, pp. 121-9.
Zechmeister I, Oesterle A, Denk P, et al. Incentives in financing mental health care in Austria. J Ment Health Policy Econ. 2002;5(3):121-9.
Zechmeister, I., Oesterle, A., Denk, P., & Katschnig, H. (2002). Incentives in financing mental health care in Austria. The Journal of Mental Health Policy and Economics, 5(3), 121-9.
Zechmeister I, et al. Incentives in Financing Mental Health Care in Austria. J Ment Health Policy Econ. 2002;5(3):121-9. PubMed PMID: 12728199.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incentives in financing mental health care in Austria. AU - Zechmeister,Ingrid, AU - Oesterle,August, AU - Denk,Peter, AU - Katschnig,Heinz, PY - 2002/06/06/received PY - 2002/12/09/accepted PY - 2003/5/3/pubmed PY - 2004/2/20/medline PY - 2003/5/3/entrez SP - 121 EP - 9 JF - The journal of mental health policy and economics JO - J Ment Health Policy Econ VL - 5 IS - 3 N2 - BACKGROUND: In Austria, financing health care -and even more so mental health care- is characterized by a mix of federal and provincial responsibilities, lack of uniformity in service provision and service providers, and diverse funding arrangements. The division between financing structures for health care and social care makes the situation even more complex. This state of affairs results in various, partly counterproductive and sometimes paradoxical financial incentives and disincentives for the providers, recipients and financiers of mental health services. In several provinces of Austria, recent reform plans in mental health care have focused strongly on establishing community-based and patient-oriented mental health care. One of the main challenges in implementing this new policy is the re-allocation of resources. AIMS OF THE STUDY: The authors hypothesize that the existing structure of mental health care financing, with its incentives and disincentives, constitutes an obstacle to patient-oriented community-based mental health care. Analyzing the characteristics of the overall mental health care financing system in one Austrian province, Lower Austria, will provide a better understanding of actor-relationships and inherent incentives and highlight implications for the process of deinstitutionalization. METHOD: The authors used an analytical framework based on the principal-agent theory, empirical evidence, and information on financial, organizational and legal structures to identify the characteristics of actor-relationships and the position of single actors within the system. RESULTS: The article shows how incentives are linked to existing constellations of actors involved in mental health care financing and identifies significant power relations. As a consequence, incentives and disincentives within the financing system result in hospital- centered and supply-oriented mental health care in Lower Austria. DISCUSSION: The current system of financing mental health care provides an obstacle to the provision of patient-oriented and community-based mental care. This is due to existing constellations and power relations among the actors where, most importantly, patients are the weakest party in the patient-payer-provider triangle. Balancing power relations will be a significant prerequisite for alternative financing systems. IMPLICATIONS FOR HEALTH POLICIES AND FURTHER RESEARCH: If a community and needs-based mental health care system is to be established in Austria, the financing structures have to be changed accordingly. Applying a principal-agent framework is useful for identifying key aspects in mental health care financing in relation to the provision of services. Further research is needed to help develop alternative financing mechanisms that support community-based and patient-oriented mental health care systems. SN - 1091-4358 UR - https://www.unboundmedicine.com/medline/citation/12728199/Incentives_in_financing_mental_health_care_in_Austria_ L2 - http://www.icmpe.net/fulltext.php?volume=5&page=121&year=2002&num=3&name=Zechmeister I DB - PRIME DP - Unbound Medicine ER -