Evaluating Mental Health Care and Policy in Spain
Research Unit, Fundacio Villablanca, Reus, University of Cadiz, Jerez and Red de Investigación en Actividades Preventivas y de Prevención de la Salud (redIAPP), Barcelona, Spain. The Journal of Mental Health Policy and Economics
(Impact Factor: 0.97).
The reform of mental health care (MHC) systems is a key health policy target worldwide. To discuss the organisation, provision and financing of MHC in Spain. We draw upon existing literature, reports and empirical data from regional and national health plans, as well as European reports pertinent to Spain. In addition an expert panel has reviewed the features of MHC, namely its history, characteristics and determinants. Spain has moved to full de-institutionalisation alongside coverage expansion and policy innovation. There remains a lack of earmarked budgets for MHC , an imbalance in MHC reforms, and a lack of monitoring of the reform process. The new focus is on how to improve coordination within and across sectors, tackle socio-economic inequalities, monitoring trends including trans-institutionalisation, services to meet the needs of new migrants, as well as those of the rural population.
Available from: Maria Luisa Rodero-Cosano
- "2. Methods 2.1. Scope of the Study In Spain, the public health system is universal with separate planning and provision and includes both public services and private ones with contract agreements (Salvador-Carulla et al., 2010). In Catalonia, the lowest level of health zoning is the basic health area (BHA), which provides primary health care. "
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ABSTRACT: The study of spatial distribution of disease is an important research field today (Bithell, 2000). In previous research, using a multi-objective algorithm clusters of high and low values of prevalence or hot and cold spot of depression in the municipal level were detected (Salinas-Pérez et al., 2012). Once these patterns were detected, it is important to analyze the risk factors that explain this type of distribution, so this study pursues to find the possible relationships that can understand the appearance of these groups in parts of the region.
Depression has been related to different socioeconomic indicators (Fryers et al., 2003, Fortney et al. 2009, Gabilondo et al, 2010; Sabes-Figuera et al, 2012.). Furthermore the research have also shown that quality indicators of heath service may be other factors involved (Fortney et al., 1999, Salvador-Carulla et al., 2008).
Taking into account that health planning used unit small area of mental health attended by a Mental Health Center and the study of spatial distribution was carried out at municipal level, to study this type of data needed specific methodologies that allows us to analyze individual and group differences in the corresponding levels. Multilevel models are methods to study variables at different levels using submodels associated with these levels within the same model, and exploring the relationship between the observation units constituting the hierarchical structure (Raudenbush & Bryk, 2002; Goldstein, 2003).
Using this methodology, the 39 municipalities that had been identified as a hot or cold spot have been related with the following risk factors: prevalence, population density, unemployment, income and educational level. In small areas of mental health included in these municipalities have been related with urbanicity, service availability, accessibility to care and adequacy or appropriateness.
The results showed significant relationships of urbanity, population density and unemployment and accessibility with high prevalence of depression, however the relationship with low prevalence of depression was shown non-significant results. Based on these results it can be concluded that this study provided an opportunity that could help to planners and decision makers in their goal of efficiency, quality and equality in mental health care.
Available from: Enric Aragonès
- "Therefore any intervention provided at a primary care centre will be available for the whole population of the related health area. The characteristics of the Spanish primary care system and the mental health system have been described elsewhere (Borkan et al., 2010; Salvador-Carulla et al., 2010). Furthermore, the programme is aligned – in its objectives and in its development – with the current priorities and strategies for addressing mental healthcare and chronicity established in Europe (Nolte and McKee, 2008; Busse et al., 2010) and with the Spanish healthcare system (Ministry of Health, Social Services and Equality, 2011; Orozco-Beltrán and Ollero Baturone, 2011). "
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Collaborative care programmes lead to better outcomes in the management of depression. A programme of this nature has demonstrated its effectiveness in primary care in Spain. Our objective was to evaluate the cost-effectiveness of this programme compared to usual care.
A bottom-up cost-effectiveness analysis was conducted within a randomized controlled trial (2007–2010). The intervention consisted of a collaborative care programme with clinical, educational and organizational procedures. Outcomes were monitored over a 12 months period. Primary outcomes were incremental cost-effectiveness ratios (ICER): mean differences in costs divided by quality-adjusted life years (QALY) and mean differences in costs divided by depression-free days (DFD). Analyses were performed from a healthcare system perspective (considering healthcare costs) and from a society perspective (including healthcare costs plus loss of productivity costs).
Three hundred and thirty-eight adult patients with major depression were assessed at baseline. Only patients with complete data were included in the primary analysis (166 in the intervention group and 126 in the control group). From a healthcare perspective, the average incremental cost of the programme compared to usual care was €182.53 (p<0.001). Incremental effectiveness was 0.045 QALY (p=0.017) and 40.09 DFD (p=0.011). ICERs were €4,056/QALY and €4.55/DFD. These estimates and their uncertainty are graphically represented in the cost-effectiveness plane.
The amount of 13.6% of patients with incomplete data may have introduced a bias. Available data about non-healthcare costs were limited, although they may represent most of the total cost of depression.
The intervention yields better outcomes than usual care with a modest increase in costs, resulting in favourable ICERs. This supports the recommendation for its implementation.
Available from: Jose A. Salinas-Perez
- "This fact was related to the direct involvement of the Spanish MH national and regional agencies in the use of the instrument for evidence-informed planning. Services from other sectors and other countries were added to the database, mental health is regarded as a paradigm of complex care including health, social, education, work and crime and justice services , and Spain has a high diversity of health and social care systems in its 17 regions . Therefore, to be fully generalizable, our results should be completed by studies comparing different countries and carried out in different health sectors. "
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The harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS).
The development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal).
DESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making.
DESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.
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