Distributional impacts of mental health care financing arrangements: a comparison of the UK, Germany and Austria.
BACKGROUND
Although mental health care has undergone substantial re-structuring processes, little attention has been paid to financing issues during these processes.


OBJECTIVE
In this paper the authors seek to examine distributional effects of systems of mental health care financing in the UK, Germany and Austria against the backdrop of ongoing reforms and broader welfare state transformations.


METHODS
The article is based on secondary data on mental health care reform processes and financing arrangements. Distributional issues are studied a) on the macro-level related to the sectors 'state', 'market', 'family' and 'voluntary/community' and b) on the individual level.


CONCLUSIONS
In all of the three countries, shifts towards community care have resulted in a new division of financing responsibilities with a tendency to rising responsibilities for the 'family' and the 'voluntary/community sector'. In addition, strengthening market principles often increases financial burdens for affected individuals and/or their relatives. The study has been limited by the lack of precise data on resource allocation and expenditure for mental health care. IMPLICATIONS FOR HEALTH POLICIES, HEALTH CARE PROVISION AND USE: An increasing focus on the relationship between financing and service provision is required in order to prevent new forms of social exclusion of people with mental disorders.


CONCLUSIONS
Further research needs to be carried out to increase transparency concerning the complex relationship between provision and the finance of mental health care. In terms of distributional impacts, it needs to be analysed in more detail which persons are affected in which ways. This particularly includes users as well as carers in the formal and informal sector.
Zechmeister
Ingrid
I
Institute of Technology Assessment/Health Technology Assessment, Austrian Academy of Sciences, Vienna. izech@oeaw.ac.at
Oesterle
August
A
D001317:Austria; D003156:Community Mental Health Services / Q000191:economics*; D005858:Germany; D006285:Health Planning / Q000191:economics*; D006801:Humans; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy*; D006113:United Kingdom