title: Using financial incentives to promote shared mental health care.
abstract: 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.
authors.affiliation: Centre for Addiction and Mental Health, Health Systems Research and Consulting Unit, Department of Psychiatry, University of Toronto, Toronto, Ontario. carolyn_dewa@camh.net
authors.forename: C S
authors.initials: CS
authors.lastname: Dewa
authors.forename: J S
authors.initials: JS
authors.lastname: Hoch
authors.forename: P
authors.initials: P
authors.lastname: Goering
mesh_terms: 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*