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Mental health system financing in developing countries: Policy questions and research responses*

Published online by Cambridge University Press:  18 May 2011

Dan Chisholm
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Abstract

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To what extent does previous and existing health economics research directly address key health system financing issues facing mental health services in developing countries? By mapping WHO's health systems framework onto mental health, three key financing questions for mental health are identified: the sufficiency of resources for mental health; the protection of individuals or households against the economic consequences of mental ill-health; and the efficient use of available resources for mental health. Research efforts to date have mainly focused on the evaluation of intervention costs in relation to mental health outcomes (the efficiency question). There is a need to achieve a greater balance between economic analysis (aimed at identifying best buys) versus financial planning (scaling up the delivery or implementation of interventions shown to be cost-effective). In addition, a better understanding and clearer articulation of the negative impact of mental disorders at the household level is needed, together with ways of alleviating financial burden via appropriate and affordable pre-payment financing mechanisms.

Type
Editorials
Information
Epidemiology and Psychiatric Sciences , Volume 16 , Issue 4 , December 2007 , pp. 282 - 288
Copyright
Copyright © Cambridge University Press 2007

Footnotes

*

The views expressed in this editorial are those of the author and are not necessarily those of the World Health Organization.

References

REFERENCES

Araya, R., Rojas, G., Fritsch, R., Frank, R. & Lewis, G. (2006). Inequities in mental health care after health care system reform in Chile. American Journal of Public Health 96, 109–113.Google Scholar
Chisholm, D. (2005). Choosing cost-effective interventions in psychiatry. World Psychiatry 4, 37–44.Google Scholar
Chisholm, D., Kumar, K., Sekar, K., Saeed, K., James, S., Mubbashar, M. & Srinivasa Murthy, R. (2000). Integration of mental health care into primary care: a demonstration cost-outcome study in India and Pakistan. British Journal of Psychiatry 176, 581–588.Google Scholar
Chisholm, D., Sanderson, K., Ayuso-Mateos, J.L. & Saxena, S. (2004). Reducing the burden of depression: a population-level analysis of intervention cost-effectiveness in 14 epidemiologically-defined sub-regions (WHO-CHOICE). British Journal of Psychiatry 184, 393–403.CrossRefGoogle Scholar
Chisholm, D., Lund, C. & Saxena, S. (2007). Cost of scaling up mental healthcare in low - and middle-income countries. British Journal of Psychiatry 191,528–535.CrossRefGoogle ScholarPubMed
Dixon, A., McDaid, D., Knapp, M. & Curran, C. (2006). Financing mental health services in low-and middle-income countries. Health Policy and Planning 21, 171–182.CrossRefGoogle ScholarPubMed
Drummond, M., Jonsson, B. & Rutten, F. (1997). The role of economic evaluation in the pricing and reimbursement of medicines. Health Policy 40, 199–215.Google Scholar
Hutubessy, R., Chisholm, D. & Edejer, T.T. (2003). Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Effectiveness and Resource Allocation 1, 8.Google Scholar
Hyman, S., Chisholm, D., Kessler, R., Patel, V. & Whiteford, H. (2006). Mental disorders. In Disease Control Priorities in Developing Countries (2nd Ed.)(ed. Jamison, D., Breman, J., Measham, A., Alleyne, G., Evans, D., Jha, P., Mills, A., Musgrove, P.). Oxford University Press: New York.Google Scholar
Mclntyre, D., Thiede, M., Dahlgren, G. & Whitehead, M. (2006). What are the economic consequences for households of illness and of paying for health care in low-and middle-income country contexts? Social Science and Medicine 62, 858–865.Google Scholar
Patel, V., Chisholm, D., Rabe-Hesketh, S., Dias-Saxena, F., Andrews, G. & Mann, A. (2003). Efficacy and cost-effectiveness of drug and psychological treatments for common mental disorders in general health care in Goa, India: a randomised, controlled trial. Lancet 361, 33–39.Google Scholar
Patel, V., Chisholm, D., Kirkwood, B.R. & Mabey, D. (2007). Prioritizing health problems in women in developing countries: comparing the financial burden of reproductive tract infections, anaemia and depressive disorders in a community survey in India. Tropical Medicine and International Health 12, 130–139.CrossRefGoogle Scholar
Ringel, J.S. & Sturm, R. (2001). Financial burden and out-of-pocket expenditures for mental health across different socioeconomic groups: Results from healthcare for communities. Journal of Mental Health Policy and Economics 4, 141–150.Google ScholarPubMed
Saxena, S., Sharan, P. & Saraceno, B. (2003). Budget and financing of mental health services: baseline information on 89 countries from WHO's project atlas. Journal of Mental Health Policy and Economics 6, 135–143.Google Scholar
Saxena, S., Thornicroft, G., Knapp, M. & Whiteford, H. (2007). Resources for mental health: scarcity, inequity and inefficiency. Lancet 370, 878–889.Google Scholar
Shah, A. & Jenkins, R. (2000). Mental health economic studies from developing countries reviewed in the context of those from developed countries. Ada Psychiatrica Scandinavica 100, 1–18.Google Scholar
Singh, B., Hawthorne, G. & Vos, T. (2001). The role of economic evaluation in mental health care. Australian and New Zealand Journal of Psychiatry 35, 104–117.Google Scholar
Srinivasa Murthy, R., Kishore Kumar, K., Chisholm, D., Thomas, T., Sekar, K. & Chandrashekar, C. (2005). Community outreach for untreated schizophrenia in rural India: a follow-up study of symptoms, disability, family burden and costs. Psychological Medicine 35, 341–351.Google Scholar
Wiley-Exley, E. (2006). Evaluations of community mental health care in low-and middle-income countries: a 10-year review of the literature. Social Science and Medicine 64, 1231–1241.CrossRefGoogle ScholarPubMed
World Health Organization (2000). World Health Report 2000; Health Systems: Improving Performance. WHO: Geneva.Google Scholar
World Health Organization (2001). Macroeconomics and Health: Investing in Health for Economic Development. Report of the Commission on Macroeconomics and Health. WHO: Geneva.Google Scholar
World Health Organization (2004). Mental Health Policy, Plans and Programmes. Mental health Policy and Service Guidance Package. WHO: Geneva.Google Scholar
World Health Organization (2005).Atlas: Mental Health Resources in the World 2005. WHO, Geneva.Retrieved September 26,2007, from http://www.who.int/mental_healthGoogle Scholar
World Health Organization (2006). Dollars, DALYs and Decisions: Economic Aspects of the Mental Health System. WHO: Geneva.Retrieved April 22, 2007 from http://www.who.int/mental_health/evidenceGoogle Scholar
World Health Organization (2007). Everybody's Business: Strengthening Health Systems to improve Health Outcomes. WHO Geneva. Retrieved November 8, 2007, from http://www.who.int/healthsystems/strategyGoogle Scholar