National Preventive Mechanism In order to enhance efficiency of the working group it is important to make a revision of its composition, define the working procedures and increase role of the group in the reform process. STATE PROGRAM AND NEW SYSTEM OF FINANCING In 2011 the title of state program was changed. The “Psychiatric Assistance Program” was replaced with “Mental Health Protection Program”, the budget was increased by 800 thousand GEL and services diversified. It shall be noted that financing of hospital component remains very high (approx. 70%), while ambulatory assistance is only about 30% and rehabilitation component – 1%. In order to ensure more balanced financing, the allocation of funds should be redistributed. New system of financing of reformed hospital services has been developed. It divides hospital services into two types: short-term hospital service covering medical treatment of acute psychosis symptomatic conditions (2-8 weeks stay); Long-term hospital service that covers situations when short-term medical is being prolonged, or medical treatment for those patients who cannot be treated outside the hospital due to grave psycho-social dysfunction. The Ministry defined that the cost of so-called “acute” hospital services shall be reimbursed upon actual expenses up to 840 GEL; as for the long-term hospital services it shall be reimbursed based on monthly voucher with the value of 450 GEL. The establishments distribute the funds allocated for short-term hospitalization in the following way: 30-40% out of the total sum distributed for 18 or 21 days (depending the duration of patient’s placement) is allocated for salaries for the whole personnel (taking into note their position). Accordingly these “allocated finances” shall be used for reimbursing salaries despite the duration of hospitalization of a patient. However if expenditure for the medical treatment of patients exceeds the prescribed amount (about 65 GEL), personnel’s salary budget is re-distributed and decreased to cover treatment expenses. Accordingly, members of staff are interested in discharging a patient within the period of 21-25 days. Moreover, the salary of personnel depends on turnover of patients as the bigger the number of patients - the higher staff salaries are. The managers of long-term hospital services note that the allocated funds are not enough for medical treatment of patients as it includes additional expensive treatment (somatic disorders) and caring means (diapers etc); accordingly difference of 400 GEL between short-term and long-term treatments is not fair. Efficiency of this financing system should be subjected to additional review and modifications. GAPS IN FINANCING SYSTEM Based on the aforementioned the Group members raised the question whether this financing system might trigger artificial increase of turnover of patients. Some directors of establishments consider that case-based financing is the reason why long-term patients are often given short-term/acute patient status. Bearing in mind that the terms acute and chronic patients are not differentiated in psychiatry it becomes easier to practice such an approach. On the one hand artificial turnover of patients is hindered by re-hospitalization control carried out by the State Regulation Agency for Medical Activities of the Ministry of Labour, Health and Social Affairs. In case a patient is re-hospitalized within 7 days after being discharged from the hospital, it is being considered that the quality of medical treatment was not adequate or the patient was discharged earlier than needed; consequently the medical establishment is obliged to return funding received for this specific case. www.ombudsman.ge NPM Report