Article Abstract Online ISSN: 1099-176X    Print ISSN: 1091-4358 The Journal of Mental Health Policy and Economics Volume 9, Issue 1, 2006. Pages: 35-44 Published Online: 23 March 2006 Copyright © 2006 ICMPE.

* Correspondence to: Ingrid Zechmeister, Strohgasse 45/3. Stock, A-1030 Vienna, Austria
Tel.: +43-1-5158 6585
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E-mail: izech@oeaw.ac.at

Source of Funding: This article is based on the results of the project `Challenges and Approaches for Mental Health Care Financing in Austria' and on the project `Mental Health Care in Vienna: A Gender-sensitive Perspective on Formal and Informal Carers and Users' (no. 27000013). The projects were funded by the Anniversary Fund for the Promotion of Scientific Research of the Austrian Central Bank (OeNB, Grant No. 9710) and the `WU Jubiläumsfonds of the Viennese Municipality'.

Abstract

Although mental health care has undergone substantial re-structuring processes, little attention has been paid to financing issues. The paper addresses distributional effects of mental health care financing systems in the UK, Germany and Austria against the backdrop of ongoing reforms and broader welfare state transformations. Distributional issues are studied a) on the macro-level related to the sectors ‘state’, ‘market’, ‘family’ and ‘voluntary/community’ and b) on the individual level. The article is based on secondary data on mental health care reform processes and financing arrangements. Results show that shifts towards community care have resulted in a new division of financing responsibilities with a tendency to rising responsibilities for the ‘family’ and the ‘voluntary/community sector’. The study has been limited by the lack of precise data on resource allocation and expenditure for mental health care. More research addressing the relationship between financing and service provision is required in order to prevent new forms of social exclusion of people with mental disorders.

Background: Although mental health care has undergone substantial re-structuring processes, little attention has been paid to financing issues during these processes. Aims of the Study: In this paper the authors seek to examine distributional effects of systems of mental health care financing in the UK, Germany and Austria against the backdrop of ongoing reforms and broader welfare state transformations. Method: The article is based on secondary data on mental health care reform processes and financing arrangements. Distributional issues are studied a) on the macro-level related to the sectors `state', `market', `family' and `voluntary/community' and b) on the individual level. Results and Discussion: In all of the three countries, shifts towards community care have resulted in a new division of financing responsibilities with a tendency to rising responsibilities for the `family' and the `voluntary/community sector'. In addition, strengthening market principles often increases financial burdens for affected individuals and/or their relatives. The study has been limited by the lack of precise data on resource allocation and expenditure for mental health care. Implications for Health Policies, Health Care Provision and Use: An increasing focus on the relationship between financing and service provision is required in order to prevent new forms of social exclusion of people with mental disorders. Implications for Further Research: Further research needs to be carried out to increase transparency concerning the complex relationship between provision and the finance of mental health care. In terms of distributional impacts, it needs to be analysed in more detail which persons are affected in which ways. This particularly includes users as well as carers in the formal and informal sector.

Received 14 June 2005; accepted 13 March 2006

Copyright © 2006 ICMPE