Increasingly countries in Europe are moving towards elaborate systems of performance assessment. Many factors have contributed to this shift. Health systems have come under intense cost containment pressures; patients expect to make more informed decisions about their treatment choices; and there have been growing demands for increased oversight and transparency in the health professions and health service institutions. At the same time advances in information technology systems have made easier to collect, process and disseminate data linked to performance.
The REFINEMENT project answers the necessity to compare and standardize the different and elaborate systems of both financing and performance assessment of Mental Health care in 9 European countries.
Refinement is organized in 9 work packages: management (WP1), evaluation (WP2) and dissemination (WP3), and technical work-packages concerned with the analysis of the financing of health and social care systems (WP4), functional and dysfunctional financial incentives (WP5), the mapping services for mental health care (WP6), the pathways of care (WP7), the quality of mental health care and met/unmet needs (WP8) and, finally, the building of the best practice models of mental health care financing (WP9).
The project has been conducted by an experienced team of health economists, mental health service researchers, public health specialists and social care experts from 9 European countries: Italy (University of Verona - project coordinator), Austria (Ludwig Boltzmann Gesellschaft), UK (London School of Economics and Political Science), Finland (Terveyden ja Hyvinvoinnin Laitos), Spain (Asociacion Cientifica Psicost), Norway (Stiftelsen Sintef), Estonia (University of Tartu), France (Université Paris XII – Val de Marne) and Romania (Institutul de Prognoza Economica).
REFINEMENT is structured in six key areas:
The quest for a common terminology faces the difficulty of cross-societal equivalence of concepts: services and structures for example may have different meanings in different countries. So, in order to compare a service or a structure across countries it is necessary to have confidence that their components and proprieties can be compared and indicate something equivalent. Such an equivalence of meaning is not necessarily obtainable through translation.
Conceptual equivalence also requires intimate knowledge of context and culture. A detailed consultation process to ensure robust concepts, and linguistic and measurement equivalence is therefore a vital element of the cross-national research process.
Glossaries in general and health glossaries in particular are distinguished between ontological glossaries and operational ones. In the ontological glossary, different meanings, cultural differences, relations and synonyms and semantically similar terms (also called "synset") have to be described in detail. In the operational glossary it is instead important to get a common language which is useful for a project (like in the REFINEMENT case) and which is agreed across the different partners (the REFINEMENT partners).
For example, in the psychiatric research area, operational glossaries are more used and one example is the Diagnostic and Statistical Manual of Mental Disorders (DSM) one approved by the American Psychiatric Association (DSM-5, 2013). An ontological glossary helps to sort out all different meanings and cultural differences of the employed terms. In other words, it is useful to develop the conceptual map and the related ontological glossary of the area of international health financing. This is very important and needed, but actually beyond the scope of the REFINEMENT project.
However, to the present days, previous comparative projects on mental health involving different European countries have encourred in the difficulty of using a common terminology but only a few (e.g. DESDE-LTC by Salvador-Carulla et al., 2013) have produced an either public or internal glossary about mental health services.
The REFINEMENT project produced its own final glossary, i.e. a pragmatic and consistent tool to define mental health care services.
The REFINEMENT project aims at comparing and standardizing the different and elaborate systems of both financing and performance assessment of Mental Health care in Europe. To achieve the goals of high quality, equity, efficiency and better long term care mixes of tax, social health insurance, private health insurance and out of pocket payments are utilized.
The REFINEMENT project analyses these mixed forms of payment to produce a comprehensive overview of links between the financing of Mental Health care in Europe and the outcomes of Mental Health services.
The REFINEMENT TOOLKIT is a DECISION SUPPORT TOOLKIT comprising:
The tools can be used either singularly or together.
The Refinement Decision Support Toolkit (DST) for improving financing of mental health care integrates five different toolkits developed through the REFINEMENT Project. The Decision Support Tool enables decision makers to evaluate key features of the mental health care system, linking financing models and payment mechanisms to indicators of structure, process and outcomes of mental health services.
FINCENTO (Financing & INCENtive Tool) is a toolkit for collecting information on key features of the health system in general in terms of regulations and funding and on key aspects of the services providing care for people with mental health needs in terms of organisation, regulation, and payment mechanisms and user charges as well as incentives and disincentives in these mechanisms.
REMAST (REfinement MApping Services Tool) is a toolkit for collecting detailed information, within a Study Area, of the structure of health care (primary, general and specialist) and social care services, that provide care for, or are used by, people with mental disorders of the working age population in terms of service distribution and utilisation. The REMAST also include description of the general context where the Study area is included and characteristics of the Study Area in terms of socio-economic environment.