Access, cost, and quality of care

in mental health

Yohannes Kinfu
Associate Professor of Population Medicine
Session outline
 Public Health & Economic Burden of mental health: An overview
 The missing link
 ‘Government intervention in health markets:
 The ‘equity’ rationale
 Market ‘imperfection’:
 Equity versus equality and horizontal versus vertical equity
 Coverage, utilization and access to health care
 Mental health for global prosperity:
 Current investment on mental health
 Global framework: Universal health coverage and universal access
Public Health and Economic Burden: An
overview
 Mental ill-health lowers quality of life, depletes personal and family
resources, feeds into the cycle of poverty, and has potential devastating
impact on the national and global economy.
Economic and public health burden: An overview
 The economic cost is
huge
The missing link: Pathways to universal access
Most persons with mental ill-
health do not have adequate
access to the essential
mental health care they
need; those who do use the
services end up paying much
of the bill.
‘Government intervention in the market for
health care
 Market imperfection – market for health care is different
 Full information, impersonal transaction, private good (social cost and social
gain), many buyers and sellers, free entry and exit etc..

 Equity as a rationale
 Equity is different to equality; distinct from the philosophical concept of
egalitarianism.

 Role of the state in health care is dependent on a complex range of historical,

political and economic factors.
Forms of equity: Horizontal equity
Horizontal versus vertical equity
Three ways of defining horizontal equity in health care:
 Equal access to health care for equal need
 Equal use of health care for equal need;
 Equal health care expenditure for equal need.

Need is used to assess the level of health disadvantage

experienced by particular groups or individuals
Forms of equity: Vertical equity
Treats people differently when the level of need among
them differs
Lessen the gap between the ‘haves’ and the ‘have nots’
Equality as a goal: Case of equality in
health outcome
•

 Do you think equality of health is a feasible goal? If yes – why? If not, why
not?

• Non-health sector determinants (such as individual choices and behavior)

• Genetic differences between people mean that complete equality of health is simply
impossible.
• May not ensure pareto optimal solution

 Trade offs between equity and efficiency (user-fee and moral hazard, clinic
distribution)
Equality as a goal: Case of equality in
access to services
•

 Can you think of any problems with measuring equality of access?

 Equality of access requires that for different communities/population
groups:
 Travel distance to facilities and services is the same.
 Transport and communications services are the same.
 Waiting times are the same.
 Patients are equally informed about the availability and effectiveness of
treatments.
 Charges are the same and ability to pay is the same.
Coverage, quality and cost: Access and
utilization of care
•

 Access (physical accessibility, affordability, acceptability)

 Utilization (availability, access (physical accessibility, affordability,
acceptability), provider behavior and adherence)
 Coverage --- potential to receive care
 Population in need of an intervention that actually received the intervention
(cervical cancer screening, childhood immunization, mental health etc..)
 Effective coverage – effectiveness and potential health gain
Mental health for global prosperity:
 2030 Sustainable Development Agenda and WHO Comprehensive
Mental health Action Plan (2013-2020)
 Financial resources are required to develop and maintain mental
health services and moving towards global program goals
Priority setting: