Value for money: a comparison of cost and quality in two models of adult mental health service provision
Year: 2012
Type: report
Abstract: Ireland's national mental health policy, A Vision for Change, describes a modern service model which is predominantly based in the community.In the mid 1980's, mental health services began to develop a community orientation guided by the previous policy document "Planning for the Future" (1984).However, acute mental health care continued to revolve in large measure around hospital-based services.The Vision Report invites mental health service providers to listen more actively to the views of service users in how services should be delivered and to engage more constructively with family members in this process.Where community-based care has been offered, service users and family members have been enthusiastic in their feedback.The previous 'Building Blocks' report provides evidence that home-based care can provide a very real alternative to hospitalisation and can greatly reduce the length of stay for those patients who do need inpatient care to help them in their recovery.Inpatient care can be disruptive and expensive for the service user as well as for the provider, and this report sets out the relative financial cost of providing inpatient-oriented versus comprehensive community-based care.A number of previous studies have established that comprehensive care in the community can be provided without compromising the quality or safety of care, and is acceptable to service users as a model of care.The current report examines the economics of the model in terms of value for money.A value for money analysis is always a valid undertaking but in the current economic difficulties, it takes on a particular importance.This report compares the true cost of delivering comprehensive acute care in the community with the cost of admission to a modern acute hospital setting.The report also uses the available financial data to compare two busy mental health sectors to illustrate the economic benefits of the comprehensive community-based model.Value for Money analysis in the HSE has been largely focussed on the reduction in the cost of services while maintaining and/or increasing the level of services across health and personal social care.Other than a small number of specific reviews, there has been little opportunity (given the scale, complexity and vast differences in the range of care and services provided) to adequately make the link between the resources used by a service, the level of services provided and the outcomes/quality experienced from the service.This study provides a robust basis for describing what is more usefully understood as a 'value and productivity' analysis of different models of service and care delivery, extending beyond the more narrow meaning usually ascribed to 'value for money'.Promoting care in the community has to be more than an ideological position: it must demonstrate equivalence in terms of clinical outcome, service-user acceptability and economic sustainability.If the quality of care is compromised, any cost-savings identified come at an unacceptable price in terms of patient care.This report demonstrates that high quality care can be delivered in the community setting in a cost-effective manner.While international studies have made similar findings, it is invaluable to have such a study conducted within the Irish context.The findings provide fresh impetus to the drive to develop accessible, responsive and high-quality community-based mental health services in Ireland.Significant new resource has been secured in 2012 to strengthen our acute community presence and we encourage all mental health service professionals, managers and planners to be guided by the findings in this excellent report in utilising this new resource.This report is the product of a multidisciplinary process involving clinicians, researchers and colleagues from the HSE Finance Directorate.We would like to acknowledge the diligent work of the authors and to thank all the participants who contributed to this timely work.The current report examines the economics of the model in terms of value for money.
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W1764962686