Using financial incentives to promote shared mental health care.
OBJECTIVE
To consider the most common primary care reimbursement structures, to identify incentives inherent in each, and to discuss how each could be used to encourage a shared-care approach to treating mental disorders at the primary care level.


METHODS
Three major financial reimbursement models--fee-for-service, capitation, and blended payment mechanisms--are examined. Each is considered in terms of its risk-sharing elements and the consequent incentives. We offer several scenarios to illustrate how the shared-care practice model might be encouraged under each financing mechanism.


RESULTS
The current fee-for-service system does not encourage shared care. For wide adoption of the shared-care practice model, there must be a change in the reimbursement system's incentives. While none of the financing mechanisms offers a perfect solution, each has potential. Each, however, must be carefully tailored to its environment.


CONCLUSIONS
Financial considerations are just one aspect to achieving shared care. Nevertheless, in designing a system to encourage collaborative, coordinated care for those suffering from mental illness, decision makers should be wary of creating or maintaining obstacles (financial or otherwise) to provision of accessible, high-quality care.
Dewa
C S
CS
Centre for Addiction and Mental Health, Health Systems Research and Consulting Unit, Department of Psychiatry, University of Toronto, Toronto, Ontario. carolyn_dewa@camh.net
Hoch
J S
JS
Goering
P
P
D002170:Canada; D002204:Capitation Fee; D003362:Cost-Benefit Analysis; D005245:Fee Schedules; D018588:Fee-for-Service Plans / Q000191:economics; D006801:Humans; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy; D009313:National Health Programs / Q000191:economics*; D010348:Patient Care Team / Q000191:economics*; D010816:Physician Incentive Plans / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*