Focus on patient problems: use of the problem-oriented record in a proposed evaluation study of social isolation.
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Hospitals, Psychiatric↗
Biomedical subjects
D R Fowler
Publications and source records attributed to D R Fowler.
The psychiatrist and health insurance claims review.
Expanded health insurance benefits for the treatment of mental illness have obliged psychiatrists to devote more time to justifying psychiatric treatment to claims reviewers. The author, drawing from experience in utilization review and peer review, summarizes factors contributing to the denial of payment for psychiatric services by health insurers, and gives practical advice on protecting against claims denials and on the process of appealing denials. Psychiatrists should make greater use of peer review committees to justify legitimate treatment services in the face of claims denials. Greater coverage for psychiatric treatment under national health insurance will increase the psychiatrist's responsibility for public accountability. This accountability will require better communication between psychiatrists and claims reviewers.
Insurance Benefits↗
A state catastrophic health insurance plan and the peer review process.
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Costs and Cost Analysis↗
Psychiatric hospitalization. I. Comparison of public and private delivery systems.
The effect of financial requirements for admission on the delivery of psychiatric treatment services was studied by comparing all patients admitted to the psychiatric services of a public and a private general hospital, serving geographically similar areas. Patients admitted to these two services (both staffed by the same Department of Psychiatry) were compared in a variety of factors relating to admission determinants, diagnosis, length of hospitalization, and type of treatment. The two patient groups differed in a number offactors, including presenting problems, diagnoses, and.psychological concept of their illnesses. The public hospital patients were less likely to receive somatic treatments (especially psychotropic drugs) and more likely to be hospitalized for longer periods than were the private hospital patients. These findings, although inconclusive because of social class, age, and sex variables, suggest that financial requirements for admission affect the intensity and expeditiousness of the treatment.
Adult↗
Psychiatric hospitalization. II. Effect of social class and delivery systems.
The effects of social class and delivery system on admission and behavioral variables, diagnosis, treatment, and length of hospitalization were studied by comparing patients admitted over a one-year period to the psychiatric services of a public and a private general hospital, staffed by the same Department of Psychiatry. Patients were of similar age and sex and were matched by social class. Crisis-precipitated admissions and affective-disorder diagnoses varied with social class irrespective of treatment facility. Patients diagnosed as schizophrenic were more common in the upper classes at the private facility and the lower classes at the public facility. Somatic treatments and length of hospitalization also varied according to social class as well as delivery system. The results of this study imply that economic differences between public and private delivery systems operate to select patients for admission and affect expeditiousness of treatment, perhaps to the detriment of patients in both systems.
Adult↗
The problem-oriented record. Problem definition.
A problem is defined when the clinician judges a dysfunction is apparent or highly probable for the patient in one or more of three areas: physiological, psychological, or social functioning. In defining specific problems, data assessments are often confounded with the data themselves. To "lump" or "split" problems in psychiatry should be by theoretical and practical considerations. Problem indicators should be "split" when the clinician believes they are not different indicators of the same problem or treatments for the problem indicators will be different. They can be "lumped" when the clinician believes they are different indicators of the same problem, or when the treatment will be the same. Criteria supporting the belief of a single problem construct are met when indicators co-vary, are functionally equivalent, or respond similarly to the same treatment variable.
Communication↗