Can staging and profiling ensure that the costs of quality care are adequately reimbursed?
background The current system for financing effective mental health can improve or reduce the quality of care provided. The system of financing includes reimbursing the care-provider, a risk-adjustment system for the health insurer and personal payments by the patient. Care-providers, patients and health insurers are worried that the current system is detrimental to quality care.
aim To find out whether the financing system can be improved by the introduction of a system which weighs the costs according to the intensity of the care provided and which is based on staging and profiling.
method We performed a critical evaluation of the current financing system and we explored how staging and profiling could help to keep complex care affordable.
results The current model for financing mental health care does not involve staging and profiling. Reimbursement is based on diagnoses and on the number of minutes of care provided, no differentiation being made between the levels of expertise required. As a result it can become financially unattractive to administer the best possible treatment to patients with the greatest needs. Staging and profiling have the potential to create the best possible relationship between the level of care needed by the patient and the treatment costs incurred, because the factors that led to the previous imbalance have been removed.
conclusion Staging and profiling can be introduced gradually at roughly the same pace as the national system of risk-adjustment is being introduced for health insurers.