The Rehabilitation in the Community of Persons with Mental Disabilities Law of Israel: Challenge and...
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Transcript of The Rehabilitation in the Community of Persons with Mental Disabilities Law of Israel: Challenge and...
The Rehabilitation in the Community of Persons with Mental Disabilities Law of
Israel:Challenge and Opportunity in a Changing Mental Health Service
System
Uri Aviram
International Workshop: Rehabilitation and Community Integration of Persons with Psychiatric Disabilities: The First Ten Years and Beyond, The
Israel National Institute for Health Policy Research, Caesarea, Israel October 13-14, 2010.
The Mental Health Rehabilitation Reform in Israel, 2000-2010
A major change in mental health services in the country
• 16,000 persons (X4 increase)• 550 programs• $125 M. annual budget ( X10 than in 2000)• 25% of the total MH budget (compared to 4%
in 2000)
2
Increase in Rehabilitation Services Budgets*, 2000-2009
3
55,311
115,525
250,215
328,663357,201
396,695418,272
444,818
050,000
100,000150,000200,000250,000300,000350,000400,000450,000
NIS
1999 2001 2002 2005 2006 2007 2008 2009
year
*Budgets include changes during the year .Constant prices based on prices of the health index of 2009.Source: State Budget, 1999-2009 and Department of Planning and Budgeting, Ministry of Health.
Budget Distribution for Mental Health Services 2009*- 1999
*Budgets include changes during the year .
Source: State Budget years 1999-20094
2009
12.30%
25.70%
62%
Inpatient Rehabilitation Other Expenses
1999
78.40%
3.80%
17.70%
Inpatient Rehabilitation Other Expenses
Number of people in rehabilitation services in the community, 1999-2009
Source: Ministry of Health, Department of Information and Evaluation and the Department of Mental Health, rehabilitation unit
5
4362
7,921
14,061
15,555
0
2000
4000
6000
8000
10000
12000
14000
16000
1999 2002 2007 2009
year
Numberofpeople
The MH Rehabilitation Act, 2000• One of the most important social laws
in Israel• Progressive by international standards• Contributing to the country's efforts to
shift the locus of treatment and care from mental institutions to the community
6
Rates of Psychiatric Hospitalizations Per 1000 people, 1999-2009
Source: Statistical Annual 2008 and personal communication, Department of Information and Evaluation, Ministry of Health.7
1
0.5
00.10.20.30.40.50.60.70.80.9
1
1999 2009
year
per 1000
Decline in the number of Inpatient days, 1999-2009
2,011,289
1,726,8561,583,202
1,414,106
1,204,6281,189,063
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
days
1999 2001 2003 2005 2007 2009
year
8
Source :Inpatient Institutions and Day care units in Israel.
Department Of Health of Information, Ministry of Health.
Objectives
• Discuss the principles and innovative approach of the Law
•Assess the opportunities and risks as the RMD law enters its second decade
• What are the Major Issues and challenges?
Outline
• The RMD Law• Effect on major changes in the mental health
service system• Methods of analysis• Focusing on population served, financial
resources, personnel, services, legislation, interest groups.
• Discussion on major issues.
10
The Rehabilitation Law- 2000
• Entitlement• Package (“Basket”) of services by Law• Professional decision• Legislature must approve changes in the
“basket”• National council to monitor and advice
government
11
Package of Rehabilitation Services
• Housing• Employment• Adult education• Social and leisure time activity• Assistance to families• Dental care• Coordination of services (case management)
12
Changes in the viability of the coalition that supported the law
• Enactment of the law: Coalition of interests, opportunity, circumstances.
• Unholy Alliance• Treasury changed position.• Effort to change the RMD law• Other interest groups and changing
circumstances
13
Maturation of the System and Necessary Organizational Changes
• Characteristics of an organization in its early development
• Needed consolidation• Rules and regulations• Personnel• Monitoring and controls• Reliable data base• Research and evaluation• Evidence based interventions
14
Major Issues of the Rehabilitation Services in the Community
• Consolidation of the system• Administration• Monitoring and control• Target population: Criteria, implementation• Budget• Market failure of privatization• Personnel• Data base, research and evaluation
15
Major Issues
• Population served• Budgets• Personnel• Services
16
Clients
• System covers only 15-20% of eligible population
• 25-30% of those who were allocated with rehab. package, never use it.
• No adequate long range plans• Changing nature of the second wave of
potential users
17
Increase in Budgets‘ Allocations1999-2009
• Budget for rehabilitation increased 10 times• Proportion of rehabilitation in MH budget
increased from 4% to 25%However
• No decrease in government hospitals’ budgets• No government hospital was closed• Decline in budget for community MH clinics
18
Budget for Mental Health Service: Inpatient* and Rehabilitation in the Community,
1999-2009**
*Inpatient includes: psychiatric hospitals, acquisitions from hospitals, and acquisitions of hospitalization substitutes.
**In thousands of NIS, constant prices based on prices of the health index of 2009.
Source: State Budget, 1999-2009
19
921,472
55,311
1,004,714
115,525
1,004,256
328,663
1,013,229
396,695
1,071,935
444,818
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1999 2001 2005 2007 2009
yearInpatient
Rehabilitation
Budgets
• Principles• need to increase base (broader coverage of eligible population).• Should reflect general population growth in the country• Must has adjustments for inflation• During the last 5 years decline in per capita budget
Average Per Capita Budget for Rehabilitation of Mentally Disabled in the Community
by planned annual growth, demographic adjustment and constant prices*
12,500
23,243
13,855
22,470
15,225
20,541
16,573
21,665
17,933
21,286
0
5,000
10,000
15,000
20,000
25,000
NIS
2005 2006 2007 2008 2009
year
number of users
average NIS percapita
*executed budget, Based on constant prices of health index 2005.Source :State budget, 2005-2010.
Potential effects of Insurance Reform
• Improvement of ambulatory services• Efforts to avoid hospitalization.• Increased demands on the rehab. Services• Possible neglect of severely mentally disabled.• “leakage” of MH money to other medical
specialties
22
Personnel
• Relate to size and quality of personnel, tasks and professional training
• Lack of headquarters personnel• Not sufficient monitoring and control• Private market tries to save money. Affects
quality of personnel• No adequate training
23
Services
• Privatization and Market Failure• Need to assess present package• Need to adapt to change in nature of
recipients• Need to adapt to changing circumstances• Need to assess current knowledge and
promote evidence-based knowledge
24
Conclusions
• Achievements are to be proud of• No assurance of continued success• Circumstances have changed• Future is unpredictable• Weak, excluded, stigmatized and weak clientele• Need political and public lobbies• Must have Long term planning• Need a flexible organization that will be able to
adjust fast
25
Thank you For you attention
26