PubMed Health⌕ Search

Biomedical subjects

S S Sharfstein

Publications and source records attributed to S S Sharfstein.

At least 73 records · Page 4Linked to original sources
PubMed1984

The impact of third-party payment cutbacks on the private practice of psychiatry: three surveys.

Recent cutbacks in private insurance benefits and publicly funded health programs are threatening the access of Americans, particularly the poor and the disabled, to private psychiatric care. The authors present the findings of three surveys that assessed the impact of threatened or actual cuts in third-party payments on the treatment provided by private practitioners. One survey indicated that, contrary to popular opinion, more than half of the psychiatrists in Northern California see severely disturbed Medicaid patients and that they provide outpatient psychiatric services to them for less cost than would public clinics. Two surveys conducted in the Washington, D.C., area indicated that both patients and psychiatrists have suffered from insurance cutbacks, with fewer patients being able to afford intensive private treatment and psychiatrists using reduced fees and less optimal treatment modalities. The fiscal and ethical dilemma posed by the cutbacks and further research needs are also explored.

Affective Disorders, Psychotic↗
PubMed1983

Psychiatric consultations at the NIH.

The history of the consultation-liaison psychiatry movement in America is briefly reviewed. Evaluation of a consultation-liaison program in a research hospital setting at NIH is described in the context of the historical paradigm.

Humans↗
PubMed1982

Relationship between alternate-day corticosteroid therapy and behavioral abnormalities.

Three patients with inflammatory or immunologically mediated disease manifested striking behavioral abnormalities in association with long-term alternate-day prednisone regimens. Of particular note was the fact that differences in the abnormalities depended on the day that the patients received their drug: the symptoms that appeared on a treatment day were opposite those present on a day of no therapy. These symptoms were reminiscent of rapid mood cycling in some patients with manic-depressive affective disorder. The phenomenon was dose related and markedly diminished in two patients as the dosage of corticosteroid was decreased, despite the fact that the alternate-day regimen was continued.

Adult↗
PubMed1982

Reductions in insurance for mental disorders: adverse selection, moral hazard, and consumer demand.

Coverage for mental illness has been sharply reduced in the Federal Employees Health Benefits Program (FEHBP), especially in the largest of the participating plans, the Blue Cross and Blue Shield plan. The authors examine the role of adverse selection (accumulation of high-risk consumers within a given plan), moral hazard (demand for services for illness depending in part on the price of the services), and lack of overt consumer demand in the current trend. They point out the critical need for psychiatry to develop more effective approaches to public education on the nature of mental illness and its treatment. If the recent major cutbacks in the FEHBP prevail, this kind of restriction is likely to become the prevailing mode of mental illness coverage under private health insurance.

Blue Cross Blue Shield Insurance Plans↗
PubMed1982

Medicaid cutbacks and block grants: crisis or opportunity for community mental health?

The fourfold growth in the mental health service system since 1955 has been largely financed by federal monies and by federal and state funding through Medicaid. This growth represents expansion of both institutional and outpatient settings, even though there has been a total reversal of the proportion of inpatient to outpatient care over the last 22 years. Current proposals to cap Medicaid costs and to issue block grants challenge the delivery system to attempt alternatives, such as financing similar to what is done in a health maintenance organization (HMO). The author describes a model of a "mental health HMO" that would be appropriate from professional consumer, and economic perspectives.

Capitation Fee↗
PubMed1981

Efficacy of psychotherapy. Asking the right questions.

Economic pressures and "value" judgments both compel and contaminate the current debate on the efficacy of psychotherapy. Too often, complex clinical trial outcome studies ignore the clinical or treatment process, as well as personality or contextual variables. Thus, they fail to build the foundations of a clinical science that makes possible the development of individually tailored treatment approaches and outcome predictions for specific patients with unique personalities, symptoms, and life circumstances. The real challenge, therefore, is for each psychotherapeutic approach to delineate its "process steps" and relate these steps to different outcomes. The "process" is the "final common pathway" for a number of patient, therapist, technique, and contextual variables. The capacity to predict the relationship between process and outcome at each stage in a therapeutic procedure is the relevant clinical test of "efficacy."

Behavior Therapy↗
PubMed1980

Accuracy of diagnostic information submitted to an insurance company.

Findings from two studies of the utilization of the mental health benefit under the Washington, D.C., area Blue Cross and Blue Shield Federal Employees Program suggest that diagnostic information submitted to insurance companies on claims forms is often inaccurate and therefore of little use for claims or peer review. The authors conclude that inaccurate information is submitted primarily because of legitimate concerns about patient confidentially. The urge that special claims and peer review procedures be developed to assure confidentiality of sensitive clinical information. A pilot project developed by the Washington Psychiatric Society and Blue Cross and Blue Shield is offered as an example of the kinds of systems that need to be devised.

Blue Cross Blue Shield Insurance Plans↗
PubMed1980

Why psychiatry is a low-paid medical specialty.

The authors examine the effect of economic forces on the income of psychiatrists and compare the economic position of psychiatry with that of the rest of medicine. Since 1970 the income of psychiatrists has been losing ground compared with that of other medical specialists, although recent data suggest a possible improvement in the economic position of psychiatry. The authors believe that psychiatrists' incomes are important as a sign of the value of psychiatric care and as one measure of the economics of practice, that is, the incentives related to the distribution of scarce technology and labor in the service delivery system.

Humans↗
PubMed1980

The Mental and Nervous Disorder Utilization and Cost Survey: an analysis of insurance for mental disorders.

The Mental and Nervous Disorder Utilization and Cost Survey in Washington, D.C., has yielded useful information about outpatient utilization within an insurance plan with broad mental health coverage, as well as evidence that a comprehensive benefit with a low deductible and copayment can be offered and reasonably utilized. From the results of this survey and a substudy of claims made during 1977, the authors conclude that psychiatric diagnostic information submitted on insurance claim forms may often be inaccurate, primarily because of providers' concerns about confidentiality; such information is of little use for peer review or claims review. The authors state that caution must be exercised in generalizing from the experience under this plan to speculate about outpatient utilization which might result from broad coverage on a national level.

Ambulatory Care↗
PubMed1979

Community mental health centers and the "seed money" concept: effects of terminating federal funds.

What happens to community mental health centers when federal funding ends? Analysis of the funding patterns of a cohort of "graduate" community mental health centers indicates that these centers remained fiscally viable subsequent to termination of basic federal grants. However, further analysis revealed two distinct funding patterns within the cohort. One group relied primarily on increased third-party reimbursements to offset the end of basic federal grants. The other sought more state funds and additional federal grants available through the Community Mental Health Center Amendments of 1975. As more centers "graduate," federal "floor funding" may be necessary to insure the survival of some of them.

Community Mental Health Centers↗