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PROGRAMA DE DOUTORAMENTO EM ECONOMIA
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Mental health inpatient care: how should services be organised in a NHS?
Publication . Matias, Maria Ana Bártolo Coelho Ramalho; Barros, Pedro Pita
Organisation of mental health care provided by hospitals can be done with concentration of
services in a few units or with several hospitals providing them. The trade-o↵ to be made is between
being closer to patients having several units of low volume activity each or benefiting from economies
of scale to obtain better outcomes. We address here the magnitude of the scale e↵ects in mental
health care. This provides important information to address the above-mentioned trade-o↵. We
also analyse the importance of integrated continuous care services in mental health as a complement
to inpatient care by computing the potential savings to the National Health Service (NHS). These
services are a set of sequential interventions in mental health and/or social support, focusing on
rehabilitation and recovery of patients with psychosocial disability. Analysing both economies of
scale and integrated continuous care are relevant issues for mental health system financing.
We use a diagnosis related group (DRG) dataset from 2001 to 2013 considering only mental health
inpatient discharges, from an European country with a case-mix based funding system (Portugal).
Using a conditional risk set model, we find a scale e↵ect for each DRG that ranges between 0
and 1 day. The magnitude of the scale e↵ect is not sufficiently high to justify the centralisation of
psychiatric services in higher volume hospitals. We find potential savings for the NHS if integrated
continuous care was in place.
The focus of mental health system redesign should be on promoting integrated mental health
care, with concentration of hospital services not being particularly relevant.
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Entidade financiadora
Fundação para a Ciência e a Tecnologia
Programa de financiamento
OE
Número da atribuição
SFRH/BD/70774/2010