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Cited by 3Health Services Management and PolicyPsychiatric care and mental health servicesHealthcare Systems and Reforms

Delaying the implementation of Payment by Results in mental health: the application of standardisation

Open access
Wang, Ruoxi, Shaw, Ian, Middleton, Hugh·2015·Mental Health Review Journal
DOI 10.1108/mhrj-03-2014-0008
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Abstract

Purpose: – The purpose of this paper is to explore the issues surrounding a long planned expansion of Payment by Results (PbR) into mental health services and to highlight the factors responsible for the delay. Design/methodology/approach: – PbR relies upon “standardisation” of conditions and treatments. This depends upon a scheme of classification that can realistically predict resources required to execute treatment of any one case. Plans to fund NHS mental health services on the basis of tariffs derived in this way have been delayed, and a key reason is the lack of high-quality data. This would require effective “standardisation-to the-average” of both a system of classification and a repertoire of costed treatment pathways. This paper investigated the delay implementation by exploring the difficulties in applying standardisation principles to service provision and tariff calculation. Findings: – The paper identified the fundamental difficulty with PbR’s implementation in applying “standardisation” to practice. This is defining the mental disorder that the patient is suffering and designing care pathways at clinical level considering the balance between practical applicability and conceptual/constructional validity. This is necessary to enable the calculation of a national tariff. The conceptual flaws of the Health of the Nation Outcome Scale led to the constructional shortcomings which compromised the credibility and validity of Mental Health Clustering Tool regarding making accurate classification in a standardised way. The validity and credibility of calculating a national tariff thus became contentious on the basis of this inaccurate clinical classification system. Originality/value: – This paper explored the driving factors of delay in implementing PbR in mental health through connecting the recent reform with the fundamental assumptions of “standardisation-to the-average”, which provided another perspective to illustrate the current obstacles.

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Crossref · 10.1108/mhrj-03-2014-0008

Cites

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  • Administrative burden and risk of gaming led to professional resistance, and the NHS mental health outcome-based reimbursement program has been indefinitely postponed in favor of smaller work areas.

    “However, the administrative burden involved and the risk of gaming (i.e., biased reporting to improve apparent performance) has led to resistance from the profession 68,69 .The program has now been indefinitely postponed in implementation in favor of smaller areas of work 70 .”

    From Measuring and improving the quality of mental health care: a global perspective (2018) · cites this paper as [70]

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Authors
Wang, R., Shaw, I., & Middleton, H.
Affiliations
University of Nottingham (GB)
ORCID
Venue
Mental Health Review Journal
Publisher
Emerald
Published
2015-09-14
Volume
20
Issue
3
Pages
156-165
ISSN
1361-9322 (ISSN-L)
DOI
10.1108/mhrj-03-2014-0008
OpenAlex
W2119772838
Cited by
3
References
29
Citations by year
2018: 1 · 2017: 1 · 2016: 1
FWCI
1.84
Type
journal article
Language
en
Open access
Licence
Locations
  • Mental Health Review Journal (publishedVersion)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
  • Nottingham ePrints (University of Nottingham) (submittedVersion)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, other-oa)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Services Management and Policy
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
Keywords
payment by results, mental health services, standardization, implementation delays, tariffs, Health of the Nation Outcome Scales, clinical classification, care pathways, data quality

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