Using financial incentives to promote shared mental health care

Objectives: To consider the most common primary care reimbursement structur es, to identify incentives inherent in each, and to discuss how each could be used to encourage a shared-care approach to treating mental disorders at the primary care level, Method. Three major financial reimbursement models-fee-for-service, capitat ion, and blended payment mechanisms-are examined. Each is considered in ter ms of its risk-sharing elements and the consequent incentives. We offer sev eral scenarios to illustrate how the shared-care practice model might be en couraged under each financing mechanism. Results: The current-fee-for-service system does not encourage shared care. For wide adoption of the shared-care practice model, there must be a chang e in the reimbursement system's incentives. While none of the financing mec hanisms offers a perfect solution, each has potential. Each, however, must be carefully tailored to its environment. Conclusions: Financial considerations are just one aspect to achieving shar ed care. Nevertheless, in designing a system to encourage collaborative, co ordinated care for those suffering from mental illness, decision makers sho uld be wary of creating or maintaining obstacles (financial or otherwise) t o provision of accessible, high-quality care.