Biomedical subjects

David Mechanic

Publications and source records attributed to David Mechanic.

25 records · Page 2Linked to original sources

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Disadvantage, inequality, and social policy.

Eliminating disparities in health is a primary goal of the federal government and many states. Our overarching objective should be to improve population health for all groups to the maximum extent. Ironically, enhancing population health and even the health of the disadvantaged can conflict with efforts to reduce disparities. This paper presents data showing that interventions that offer some of the largest possible gains for the disadvantaged may also increase disparities, and it examines policies that offer the potential to decrease disparities while improving population health. Enhancement of educational attainment and access to health services and income support for those in greatest need appear to be particularly important pathways to improved population health.

Adult↗

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Removing barriers to care among persons with psychiatric symptoms.

Many persons with serious psychiatric conditions who could benefit from available treatments do not receive care, and the barriers are generally understood to be limited knowledge, inadequacies in insurance coverage, and stigma. Sophisticated approaches are needed to realistically eliminate these and other barriers. Public policy should focus on criteria for need for care and encourage interventions that facilitate treatment when it can be helpful. Appropriate insurance coverage is indispensable, and achieving mental health parity will require careful management of care. Policymakers must help to create a trustworthy management structure that is inclusive, that develops and disseminates models of best practice, that encourages evidence-based decision processes, and that ensures continuing dialogue and procedural fairness in managed care decision making.

Health Education↗

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Employing persons with serious mental illness.

Data from various national surveys find that approximately half the population with mental disorders is gainfully employed across the entire range of occupations; such persons have an employment rate of about two-thirds that of the general population. More than a third of persons with serious mental illness also work, and many hold high-status positions. Among those with schizophrenia, a diagnosis associated with high impairment, only slightly more than a fifth are at work, and 12 percent are working full time. Approximately two-thirds are enrolled in federal disability insurance programs. Our analyses indicate considerable diversity of jobs among persons with various mental disorders. Most persons with mental illness want to work, and some with even the most serious mental disorders hold jobs requiring high levels of functioning. Educational attainment is the strongest predictor of employment in high-ranking occupations among both the general population and persons with mental disorders.

Activities of Daily Living↗

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Is the prevalence of mental disorders a good measure of the need for services?

Mental disorders are highly prevalent, but prevalence is different from need for treatment. Some mental disorders are a major source of distress, disability, and social burden, and many people who could benefit from treatment do not receive it. Need is typically self-defined or defined by clinicians who are motivated to bring treatment to those who could benefit. Defining need appropriately requires consideration of the duration and reoccurrence of disorder, associated distress and disability, and the likelihood that treatment will be beneficial. Demand may be promoted inappropriately by clinicians and drug manufacturers who profit from expansion of demand. Future assessments of need must be based on evidence and take into account priorities for care and cost-effectiveness.

Cost-Benefit Analysis↗

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Treatment of people with mental illness: a decade-long perspective.

Many believe that managed behavioral health care has been associated with reduced access to care. Data from a variety of sources suggest that access has increased, although patterns of care and locations of treatment have changed. Data from Healthcare for Communities, a nationally representative community survey, show that access to care has not decreased for people with the most serious conditions who were more likely to receive specialty mental health care after 2000. Further, once people enter specialty care, the number of visits appears unrelated to need. The data highlight the urgent need for a greater focus on the quality of care and patient outcomes.

Data Collection↗

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Policy challenges in addressing racial disparities and improving population health.

Socioeconomic status fundamentally affects most health and disease outcomes, but black Americans are doubly disadvantaged by low status, discrimination, and residential segregation. Improving health and removing disparities are essential goals, but some efforts that improve the health of blacks in important ways also increase black-white disparity ratios. People with more information, influence, resources, and social networks may be better able to take advantage of new technologies and scientific developments, initially increasing disparities. Better health and reduced mortality should be the key policy criteria, but these criteria should be linked with consideration of careful targeting to level the playing field and close disparities.

Black or African American↗

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Rationing medical care.

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Cost-Benefit Analysis↗