Análisis
Published on 4 de junio de 2024 | http://doi.org/10.5867/medwave.2024.05.2920
Exploratory analysis on payment mechanisms to Community Mental Health Centers in Chile using mixed grounded theory
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Consistency between payment unit and CMHM incentives in CMHC.
| Mitigate the negative effects of the social and economic context of the users. | Introduction of risk adjustment factors in the payment mechanism that has been established. Complementary programs that link tariffs to performance targets. |
| Consider cultural particularities | |
| To be better prepared to face health contingencies. | |
| Universal and selective promotion and prevention interventions are carried out jointly with social or intersectoral organizations. | Payment by capitated population according to assigned population (public insurance beneficiaries of the territory in charge) based on annual intervention process goals. |
| Differentiated care according to the needs of the users. | Payment associated with the complexity of resource consumption. The case definition groups diagnoses according to the homogeneity of resource use and clinical characteristics, generating various groups to which a fee is determined according to complexity. |
| Explicit identification of therapeutic interventions that are considered to identify the community mental health model (consultancy, home visit, self-help group, intervention plan co-constructed with the user, others). | |
| Comprehensive recovery, shared care and continuity of care. | Pay-for-performance for shared care cases. This involves setting the performance goal for the organizations involved simultaneously. |
| Stable, motivated and competent mental health teams. | The current regulation on contractual conditions of healthcare workers in Chile’s public healthcare system determines the maintenance of a prospective budget to support the payroll.. |
| Efficient administrative support processes | Incorporated in estimating the rates in any of the payment mechanisms, but their incorporation must be explicit through some calculation rule. As part of performance goals under a complementary bonus mechanism. |
CMHC, community mental health centers; CMHM, community mental health model.
Source: Prepared by the authors of this study.