Transcript Document

Outlining the Scope for Public Sector Involvement
In Mental Health
MUSGROVE’S MAIN CRITERIA
1. Is the burden high?
6. Is private demand for health care adequate?
2. Is health a public good?
7. Do cost-effective interventions exist?
3. Are there externalities associated?
8. Can care be insured?
4. Does the disorder inflict catastrophic costs?
9. Do the rules of rescue apply?
5. Does the disorder affect the poor
disproportionately?
10. For provision in the private sector, is there a
role for government regulation?
APPLYING MUSGROVE’S CRITERIA TO MENTAL HEALTH
1. YES, as reflected in the World Health
Report 2001.
Burden of Neuropsychiatric Conditions as
a Proportion of Total World Burden of Disease
6. MOST LIKELY NOT. Individuals often do not
attribute their symptoms to mental illness, do
not know that effective treatments exist or avoid
treatment because of stigma.
7. INCREASING EVIDENCE. For some
DALYs
Disability
12%
31%
2. NO, because the benefit accrues to the
persons being treated and, to some
extent, their families
3. YES, in some cases. For conditions such as
psychosis there may be a risk to others if the
person with untreated illness becomes
dangerous or commits crimes.
disorders, such as depression, anxiety and
epilepsy, effective treatment can be
provided through primary health care.
8. MUST BE MANDATED. Failures in an
insurance market are more marked than for
other health conditions due to stigma, adverse
selection and moral hazard.
9. YES, for suicide prevention.
10. YES, to ensure quality (esp. since treatment
can be involuntary), provide information
(information asymmetry high for some mental
health consumers) and regulate any
insurance market to mandate coverage.
4. YES, some conditions such as schizophrenia
are very disabling and may require expensive
hospital care.
5. INCREASING EVIDENCE. Individuals with
disabling illness cannot work and, as a result,
slip into poverty.
IMPLICATIONS
Musgrove organizes the main criteria relevant to public health decision-making. This
framework was used in the World Health Report 2000. While the framework was not
specifically intended to be applied to mental health, it can be readily applied to this field to
help policymakers define the scope for public involvement (especially public financing).
Musgrove, P. (1999) Public spending on health care spending: how are different criteria related? Health Policy, 47:207-223.