Shaping National Policy: Delegation and Decentralization of Mental Health Care

Over the past 2 decades there has been a trend among industrialized nations of delegating responsibility for the delivery and financing of mental health care to lower levels of government, private organizations, or both.This trend reflects several hopes, for example, that the organizations assuming responsibility will bring greater expertise to this task, will be more efficient, and less costly. However, the trend also raises a number of concerns, such as fears of undertreatment and of poor quality of care. In delegating this responsibility, payers for mental health care must carefully consider how to structure incentives for those organizations assuming the responsibility in order to ensure adequate access to high quality services. (February 1996)