Challenges facing mental health systems arising from the COVID-19 pandemic: Evidence from 14 European and North American countries.

We assessed challenges that the COVID-19 pandemic presented for mental health systems and the responses to these challenges in 14 countries in Europe and North America. Experts from each country filled out a structured questionnaire with closed- and open-ended questions between January and June 2021. We conducted thematic analysis to investigate the qualitative responses to open-ended questions, and we summarized the responses to closed-ended survey items on changes in telemental health policies and regulations. Findings revealed that many countries grappled with the rising demand for mental health services against a backdrop of mental health provider shortages and challenges responding to workforce stress and burnout. All countries in our sample implemented new policies or initiatives to strengthen mental health service delivery - with more than two-thirds investing to bolster their specialized mental health care sector. There was a universal shift to telehealth to deliver a larger portion of mental health services in all 14 countries, which was facilitated by changes in national regulations and policies; 11 of the 14 participating countries relaxed regulations and 10 of 14 countries made changes to reimbursement policies to facilitate telemental health care. These findings provide a first step to assess the long-term challenges and re-organizational effect of the COVID-19 pandemic on mental health systems in Europe and North America.

Models for projecting supply and demand for nurses in Israel.

BACKGROUND: Concern is growing over serious shortages in the nursing workforce and imbalance between supply and demand. Projections indicate that the demand for the nursing workforce will increase due to the aging population and an increase of the percentage of elderly people requiring assistance. STUDY GOALS: To examine the expected balance between supply and several demand projections for nurses in Israel in order to contribute to planning the nursing workforce. METHODS: 1. Open interviews with key figures in the healthcare and nursing care systems; 2. Examination of supply and demand for nurses; 3. Examination of the balance between supply and demand projections. MAIN FINDINGS: A considerable gap was found between the supply and demand projections for registered nurses, which will increase over time according to each of the demand projection models up to 2030. All of the models indicate that the projected shortage will be significantly affected by the age at which the nurses retire. Models based on a fixed ratio of nurses or infrastructure (beds, positions) per population show a particularly great gap between demand and supply. However, a more conservative model (based on hospital utilization), that takes the system's infrastructures and limitations, as well as the growing population and changes in its composition into account, without an increase in the direct ratio of the number of nurses, also predict a significant shortage of nurses within 20 years. CONCLUSIONS: The gaps between the demand and supply projections indicate the need to augment the workforce in addition to the steps currently taken to recruit nursing staff and increase the number of training institutions for nurses. The relatively simple supply prediction models, which are based on available sources of information that can be easily revised, will make it possible to monitor and update projections regularly over time. The models developed in this study should help the process of long-term strategic planning for the number of nurses in Israel.

Work practices and the provision of mental-health care on the verge of reform: a national survey of Israeli psychiatrists and psychologists.

BACKGROUND: The State of Israel is preparing to transfer legal responsibility for mental- health care from the government to the country's four competing, nonprofit health-plans. A prominent feature of this reform is the introduction of managed care into the mental-health system. This change will likely affect the service delivery patterns and care practices of professional caregivers in mental-health services. The study examines psychiatrists' and psychologists' patterns of service delivery and practice, and their attitudes toward the reform's expected effects, focusing on the following questions: To what extent do today's patterns of service delivery suit a managed-care environment? To what extent do professionals expect the reform to change their work? And do psychiatrists and psychologists differ on these questions? METHODS: A survey of 1,030 psychiatrists and psychologists using a closed mail questionnaire for self-completion was conducted from December 2011 to May 2012. RESULTS: Substantial differences were found between psychiatrists' and psychologists' personal and professional characteristics, work patterns, and treatment-provision characteristics. In addition, the study identified gaps between the treatment-provision characteristics of some of the professionals, mostly psychologists, and the demands of a managed-care environment. Moreover, a high percentage of the mental-health professionals (mostly psychologists) do not expect improvement in the quality of care or its accessibility and availability following the reform. However, those reporting practices associated with managed care (e.g. short-term treatment, compliance with monitoring procedures, and emphasis on evidence-based treatment) are less likely to expect negative changes in the provision and quality of care after the reform. CONCLUSIONS: Steps need to be taken to reduce the gaps between the treatment-provision characteristics of the professionals and the demands of a managed-care environment, and there are several possible ways to do so. In order to recruit experienced, skilled professionals, the health plans should consider enabling various work models and offering training focused on the demands of working in a managed-care environment. It is advisable to implement this kind of training also during the training and specialization process by including these topics in the professional curricula.

The impact of an integrated hospital-community medical information system on quality of care and medical service utilisation in primary-care clinics.

BACKGROUND: In 2005, an innovative system of hospital-community, on-line medical records (OFEK) was introduced in Clalit Health Services (CHS). GOALS: To examine OFEK's use and impact on quality indicators and medical-service utilisation in CHS primary-care clinics. METHODS: Examining the frequency of OFEK's use with its own track-log data; comparing 'before' and 'after' quality indicators and service utilisation of experimental versus control clinics. RESULTS: Use of OFEK increased by hundreds of percent between 2005 and 2006, continued rising at a slower rate in 2007 and decreased slightly in 2008. At clinics in catchment areas of hospitals using OFEK extensively, OFEK reduced the number of imaging tests and, to a lesser extent, laboratory testing and improved several quality measures. An examination of all clinics in the catchment areas and in the study revealed a much weaker impact. CONCLUSIONS: OFEK's introduction affected a number of outcome measures - some, significantly - in medical and financial terms. Its increased use at additional clinics may exert a stronger impact there, too. The study contributes to the development of measures to examine the impact of such systems, which can be used to assess a broad range of Health Information Technology (HIT) systems.

The impact of an integrated hospital-community medical information system on quality and service utilization in hospital departments.

PURPOSE: In 2005, an innovative system of hospital-community on-line medical records (OFEK) was implemented at Clalit Health Services (CHS). The goals of the study were to examine the extent of OFEK's use and its impact on quality indicators and medical-service utilization in Internal Medicine and General Surgery wards of CHS hospitals. METHODS: Examining the frequency of OFEK's use with its own track-log data; comparing, "before" and "after", quality indicators and service utilization data in experimental (CHS patients) versus control groups (other patients). RESULTS: OFEK's use increased by tens of percentages each year, Internal Medicine wards showed a significant decrease in the number of laboratory tests and 3 CT tests performed compared with the control group. Wards using OFEK extensively showed a greater decrease in CT tests, in one imaging test, and in the average number of ambulatory hospitalizations. No similar changes were found in General Surgery wards. CONCLUSIONS: The study helps evaluate the extent to which OFEK's targets were achieved and contributes to the development of measures to examine the impact of such systems, which can be used to assess a broad range of Health Information Technology (HIT) systems.

Israel: health system review

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. Israel has a national health insurance (NHI) system that provides a broad benefits package to the population. There is free choice among four competing, non-profit-making health plans that receive NHI funds from the Government according to a capitation formula. The system is financed primarily from public sources via payroll and general tax revenues. Health care accounts for approximately 8% of gross domestic product (GDP). Hospitals and public clinics each account for approximately 40% of national health expenditure, and dental care accounts for a further 10%. In recent years the share of public financing has declined to 64% of total health system financing, while the shareof private financing, especially voluntary health insurance and co-payments, has increased to 36%. In recent years the Ministry of Health has developed strong capabilities in the areas of technology assessment, the prioritization of new technologies, health plan regulation, quality monitoring for community-based care, as well asstrategic planning, to set goals for population health and strategies for achieving them. Critical components of the Israeli health system include: a sophisticated public health effort, run by the Ministry of Health; high-level primary care services provided by the health plans; highly sophisticated hospital care; and a strong system of emergency care delivery.