Standard comparison of local mental health care systems in eight European countries

Aims. There is a need of more quantitative standardised data to compare local Mental Health Systems (MHSs) across international jurisdictions. Problems related to terminological variability and commensurability in the evaluation of services hamper like-with-like comparisons and hinder the development of work in this area. This study was aimed to provide standard assessment and comparison of MHS in selected local areas in Europe, contributing to a better understanding of MHS and related allocation of resources at local level and to lessen the scarcity in standard service comparison in Europe. This study is part of the Seventh Framework programme REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care in Europe) project. Methods. A total of eight study areas from European countries with different systems of care (Austria, England, Finland, France, Italy, Norway, Romania, Spain) were analysed using a standard open-access classification system (Description and Evaluation of Services for Long Term Care in Europe, DESDE-LTC). All publicly funded services universally accessible to adults (>= 18 years) with a psychiatric disorder were coded. Care availability, diversity and capacity were compared across these eight local MHS. Results. The comparison of MHS revealed more community-oriented delivery systems in the areas of England (Hampshire) and Southern European countries (Verona - Italy and Girona - Spain). Community-oriented systems with a higher proportion of hospital care were identified in Austria (Industrieviertel) and Scandinavian countries (Sor-Trondelag in Norway and Helsinki-Uusimaa in Finland), while Loiret (France) was considered as a predominantly hospital-based system. The MHS in Suceava (Romania) was still in transition to community care. Conclusions. There is a significant variation in care availability and capacity across MHS of local areas in Europe. This information is relevant for understanding the process of implementation of community-oriented mental health care in local areas. Standard comparison of care provision in local areas is important for context analysis and policy planning.Peer reviewe

Physician migration at its roots: a study on the emigration preferences and plans among medical students in Romania

Abstract Background Migration of healthcare workers is receiving increased attention worldwide. In Europe, the creation of a border-free labor market and its expansion with the EU enlargements of 2004, 2007, and 2013 endowed health professionals with the right to provide services and to relocate to another EU Member State. For the Romanian doctors, the EU-wide recognition of the medical degree obtained in Romania has created new opportunities, while inadequate working conditions and relatively low salaries pushed many of them to search for employment abroad. As there is considerable uncertainty about the magnitude of the Romanian physicians\u2019 exodus, we performed a survey to assess the emigration intention of future Romanian doctors. Methods The study was conducted over three consecutive years: 2013, 2014, and 2015 at the University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d Cluj-Napoca, Romania. The self-administrated questionnaire included 19 questions regarding students\u2019 emigration intentions. Results All the 957 license-degree students participated in the study. In this study, 84.7% of subjects planned on seeking employment abroad after graduation. A large number of the students who have participated in the study have already started preparing for emigration, 21.7% of those who wished to migrate had already performed at least one Erasmus mobility in their country of choice, 44.5% have been enrolled in a language course, and 42.7% have searched for jobs on the Internet. Conclusions The majority of Romanian medical students considering migration see it as a serious alternative to the continuation of their professional training started in Romania. The findings of this study are upsetting and can impact both policy crafting and future research. Structural reforms in the healthcare provisions are needed in order to facilitate the retention of medical personnel. Romanian policy makers need to devise a comprehensive national health workforce plan to deal with physician migration