Delaying the Implementation of Payment by Results in Mental Health: the Failure of Quasi-market

Purposes: To investigate the policy-making process of introducing a prospective payment method called ‘Payment by Results in mental health’in England and to identify the factors that caused the delay in implementation. This study carried out a three-stage analysis using mixed-methods. Firstly, the feasibility of applying Quasi-market theory in mental health care at the fundamental level was theoretically analysed. Then, the validity of the construction of the classification system and the cost calculation mechanism at the mechanical levelwas theoretically evaluated. And lastly, 12 semi-structured interviews with actors from different interest groups (commissioners, hospital managers and frontline clinicians) was conducted to investigate the practical obstacles that hindered the implementation; and conducted 51 online surveys to testify the corresponding findings at the practical level. Results from the empirical data were triangulated with the literature. The following barriers to implementation were identified: 1) Mismatches between the Quasimarket theory and mental health services; 2) Complex nature of mental disorder and inaccurate data from the classification system; and 3) Gaps between political intent and frontline including (a) inappropriately set targets(b)increasing workload(c) lack of sufficient training and (d) ‘gaming’ behaviour. Implementing PbR policy in mental health failed to serve the purposes of improving efficiency and quality,given the fundamental problems of the commodification of mental health services, theconstructional flaws in defining the mental disorder and the corresponding needs for care, along with the practical difficulties resulted from the gaps between the political intent and the frontline reality.