Welfare Reform on the Web (December 2006): Mental health services - Overseas

Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

R. Raghavan and others

Children and Youth Services Review, vol.28, 2006, p.1482-1496

Bringing children with mental health needs under an insurance umbrella has been a priority in the USA for the past several decades. A stable source of health insurance is particularly important for young people in the child welfare system, given their disproportionately high levels of need for mental health services and their reliance on Medicaid to pay for those services. Medicaid has undergone significant structural changes, the principal of these being the rise of Medicaid managed care. Medicaid managed care affects children in the welfare system in three important ways:

• From a primary care perspective, it offers significant advantages for enrollees, including a focus on prevention, co-ordination of care, increased access to ambulatory services, reductions in emergency department use, and expanded benefit structures.
• Much behavioural health care under Medicaid is contracted for separately from physical health services with specialist organisations.
• Managed care displays variations in mental health provider reimbursements.

Health system factors impacting on delivery of mental health services in Russia: multi-methods study

D. McDaid and others

Health Policy, vol.79, 2006, p.144-152

This study evaluated how the regulatory environment and health system organisation, financing and provider payment systems influence the delivery of mental health services in the Sverdlovsk region of Russia. Results showed that mental health services are still largely provided in hospitals, although the need for more community-based services is widely recognised. Resource allocation and provider payment systems remain largely unchanged from Soviet times and favour large inpatient institutions, creating incentives for hospitals to maintain large numbers of beds and staff. Community-based social services and human resources remain limited, especially in the areas of social work, housing support and vocational rehabilitation.

Some economic dimensions of the mental health jigsaw in Australia

R.F.G. Williams and others

International Journal of Social Economics, vol.33, 2006, p.808-831

This paper first presents some aggregate economic data for Australia as a whole on dedicated public psychiatric hospitals. Queensland government expenditure is then singled out for analysis. Next, data on private fee-for-service psychiatric services are studied in some detail, in order to shed light on the operation of Medicare in this area. Evidence is found that expenditures on psychiatric hospitals have fallen. Further evidence was found of a decline in the absolute and relative size of private practice psychiatry since the mid 1990s.

A suggested push model for interpreting the dilemmas of institutional care, community care and family care of mental-health consumers

K.-S. Yip

International Social Work, vol.49, 2006, p.805-817

This analysis suggests that in the UK and the USA the closure of mental hospitals and the discharge of their patients has led to the overloading of community care services, especially as families have proved reluctant to assume caring responsibilities. In Hong Kong, in contrast, family caregivers are severely burdened by poor community care and highly institutionalised services. The author shows how in each case the various groups involved in the care of mental health service users try to offload their responsibilities onto someone else.