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Presentation

Session: Posters
Room: TBA
Time: Fri 13:00-14:30

Presenter: Ana Santos (National School of Public Health, Nova University of Lisbon. )

Abstract

Introduction: In mental health care services’ different patients treatment needs, patterns of care, and levels of resources used are present. However, mental health services have been funded without taking into consideration those differences and not reflecting levels of complexity. In Portugal, a prospective payment system based on Diagnosis Related Groups (DRGs) has been in place since 1997 for acute care hospitals meaning that psychiatric patients admitted to those facilities have been funded according to the case-mix they present. Nevertheless, DRGs may not be suited to group and finance patients admitted into psychiatric hospitals providing long term care. However, three of those psychiatric hospitals have been using DRGs to group their inpatients since 2003. It was observed that close to 84% of all their inpatient episodes were grouped into DRG 426: Depression Neurosis and DRG 430: Psychosis (AP-DRGs v 21.0) (ACSS, Base Nacional de Dados GDH, 2009). Inpatient care in psychiatric hospitals is funded through a per diem based solely on the patient’s length of stay.
Aims: The goals of the current work were twofold: should the case-mix system in place for acute care hospitals be used to finance mental health care in Portugal? Should another patient classification system more targeted for mental health care be adopted in Portugal?
Methods: A review of the literature was done for the development and use for funding purposes of mental health care patient classification systems in Australia, Canada and the USA. Mental health care in Portugal was described according to its inpatient and outpatient volume and also to its geographical distribution. Bearing this information in mind, it was sought to evaluate the feasibility of implementing a case-mix system to fund mental health care facilities in Portugal.
Conclusions: The analysis makes clear the importance of tailored patient classification systems as a basis for the description and financing of mental health care. Its adoption enables a better and more accurate understanding of the several factors driving the costs of mental health care while at the same time provides some leads regarding cost-saving strategies. In one’s opinion the selected classification system should favor a rapid implementation and not involve burdensome investments but at the same time promote a fair resource allocation.
This work as intended to be a first approach to this subject and it is being continued in order to provide more thorough information for the decision making process.

Key Terms

mental health, psychiatry, case-mix, Portugal, patient classification system, financing system

Authors:

Ana Santos (National School of Public Health, Nova University of Lisbon) and Céu Mateus (CIESP National School of Public Health, Nova University of Lisbon)

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