Payment systems and hospital resource use: a comparative analysis of psychiatric, medical and obstetric services.
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Adult↗
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Psychiatric findings among child psychiatric inpatients grouped by public and private payment.
OBJECTIVE: The study compared school-age psychiatric inpatients whose care was publicly funded with those whose care was privately funded to determine whether the public patients presented with more psychiatric risk factors and more psychiatric problems. METHODS: Retrospective chart review was used to collect data on the demographic and personal characteristics, behavior in the hospital, and response to milieu treatment of 40 public patients and 40 private patients. Half of each group were admitted during 1985-1986, and half during 1991-1993. Characteristics of the two groups were compared, and trends over time were examined. RESULTS: The public group presented for hospitalization with significantly more risk factors and psychiatric problems. Public status predicted the use of certain interventions, such as time-outs and physical holding. Public patients responded less positively to the treatment program. They had three times the number of bed-days as the private group during 1991-1993. CONCLUSIONS: Public patients require more intensive and extensive inpatient treatment and will be more profoundly affected by the restrictions on psychiatric inpatient care in the current climate of fiscal restraint.
Adolescent↗
High users of outpatient mental health services, I: Definition and characteristics.
Mental health coverage generally limits benefits for high use, which is assumed to be discretionary. The authors present data from the National Medical Care Utilization and Expenditure Survey. Of the individuals who made mental health outpatient visits in 1980, 9.4% made 25 or more visits and accounted for 50% of mental health visits and expenditures. These high users were compared with low users and with high users of other health care. One-third of the mental health high users were highly disabled and had multiple medical disorders. The authors point out the heterogeneity of this population and suggest that psychiatric benefits be differentiated according to patients' needs and services offered.
Ambulatory Care↗
Developing a level III/IV medical/psychiatry unit. Establishing a basis, design of the unit, and physician responsibility.
This article is part of a series defining the administrative, logistical, and funding issues necessary for the establishment of a medical/psychiatry unit. It emphasizes the experience of individuals who have developed such units and is offered in an attempt to prevent duplication of costly mistakes. Administrative issues, factors affecting the physical design of the unit, requirements for medical coverage and medical and psychiatric programmatic support, and the ethical issues encountered in managing such a unit are discussed.
Delivery of Health Care↗
The effects of outpatient psychiatric utilization on the costs of providing third-party coverage.
Although previous studies conducted in prepaid group practice settings have indicated that the cost of providing coverage for outpatient psychotherapy may be offset by lower utilization of medical/surgical services among those who receive the benefit, no such studies have been conducted in a fee-for-service setting, nor have actual before and after claims costs been compared. This study establishes a methodology for using routinely collected Blue Cross claims data to show how the acquisition and use of a given benefit affects total utilization patterns and the overall costs of providing third-party coverage. The use and cost of outpatient psychiatric coverage in one subscriber group is the particular application given to this methodology in this report. Blue Cross claims records of 136 subjects who utilized outpatient psychiatric benefits over a 48-month period were analyzed. Results indicate that overall medical/surgical utilization is reduced for that subgroup who used the outpatient psychotherapy benefit and that average costs dropped by $9.41, from $16.47 per patient per month before outpatient psychotherapy to $7.06 after contact, with costs being adjusted to reflect parity with the base year. Factors other than psychiatric intervention which may have brought about this cost reduction as well as policy implications of these results are discussed.
Ambulatory Care↗
Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); mental health services--Department of Defense. Final rule.
This final rule establishes a mandatory preadmission authorization program for mental health services under CHAMPUS. Such a program is needed to promote quality assurance and contain rapidly increasingly costs in inpatient psychiatric care under CHAMPUS. By maintaining most of the procedures of the current voluntary preadmission authorization program, the final rule minimizes inconveniences for providers.
Adolescent↗
Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); mental health services--Department of Defense. Final rule.
This final rule implements changes required by the National Defense Authorization Act for Fiscal Year 1992 and the Department of Defense Appropriations Act for Fiscal Year 1991, as amended by the Persian Gulf Conflict Supplemental Authorization and Personnel Benefits Act of 1991, concerning mental health services under CHAMPUS. The Acts change the existing day limits and waiver criteria for acute inpatient psychiatric care, introduce new day limits for residential treatment center care, and protect against economic interests in referrals to inpatient facilities by health care professionals.
Cost Control↗
Psychiatric treatment programs: the continuous services model.
With the inclusion of behavioral managed care in the design of many benefit plans, the delivery of psychiatric care has changed. The continuous services model offers advantages for both employers and employees who utilize mental health benefits.
Adult↗
Financing the medical management of mental disorders.
In 1987 Medicare benefits for the mentally ill were expanded for the first time in 22 years. A major change was the removal of limits and copayments for the "medical management of psychopharmacologic agents." Payment for medical management recognizes the trend toward the remedicalization of psychiatry; however, medical management can be defined either broadly or narrowly. The authors suggest pricing strategies for both medical management of mental disorders and psychotherapy. Enlightened design of psychiatric benefits will cover all forms of treatment according to appropriate rules. Access to treatment for mental illness is at stake as these rules develop.
Costs and Cost Analysis↗
Less is more? Today's economics and its challenge to psychiatry.
Escalating costs of medical and psychiatric care have prompted a reevaluation of the health care delivery system and practice styles. There are several "procompetition" or market-based solutions that seek to make the consumer of care more price conscious and the provider of care more cost conscious. Diagnosis-related groups (DRGs), preferred provider organizations (PPOs), the growth of for-profit hospital systems, and the expansion of health maintenance organizations (HMOs) are reshaping the organization and financing of psychiatric care. Psychiatry's adaptation to the new medical economics must emphasize the quality of patient care.
Delivery of Health Care↗
Cost-effectiveness of providing mental health services: the offset effect.
An offset effect occurs when the provision of one type of service leads to a reduction in the use of other related services. This article examines the offset which occurs in medical utilization when mental health services are appropriately provided, especially within prepaid group health care settings. While no study in this area is free of methodologic flaws, the weight of the evidence strongly suggests that, within such settings, the provision of psychiatric input not only provides a service which is indispensible to the concept of comprehensive health care, but also is affordable, in part because of the realization of offset effects.
Cost-Benefit Analysis↗
Finding psychiatric diagnosis-related groups that work: a call for research.
Diagnosis-related groups (DRGs) are under consideration as a way to pay hospitals for psychiatric care. Yet psychiatric DRGs account for only 3% of the variation in how long patients stay in the hospital. This nearly random variation means that psychiatrists may be working under a payment system that will have little relation to clinical reality. The authors identify important flaws in the current psychiatric DRGs and describe an alternative approach that promises to reflect clinical reality much more accurately.
Diagnosis-Related Groups↗
Nowhere else to turn. As the ax falls on mental health funding, hospital EDs fill the gap--reluctantly.
As the ax falls on mental health funding, state mental hospitals are closing and investor-owned psychiatric organizations are filing for bankruptcy or shifting their focus to more lucrative general acute care services. That leaves patients--many of them uninsured--with nowhere to seek help except hospital emergency departments.
Emergency Service, Hospital↗
[The reform of psychiatric care in Poland--2001].
Both positive and negative effects of the reform of the health care financing system are noted. Low prices offered by Sickness Funds for particular services (a bed-day, a visit) should be regarded as a negative effect of the reform. Particularly insufficient were the prices of services in some specialised psychiatric wards and in outpatient clinics. Prices in many community-based psychiatric facilities were also considerably underestimated. Undoubtedly, the reform has led to positive changes in the organization of inpatient care. These changes include: further reduction of beds in large hospitals organisational structure as well as a marked increase in the number of psychiatric wards at general hospitals, which should be the key units of psychiatric inpatient care. Increase in the number of day hospitals is another positive effect of the reform. The programme of psychiatric care transformation is presented mostly in the Mental Health Programme. The main goal of this programme is to ensure appropriate care for the mentally disordered people, namely comprehensive and accessible health care as well as other forms of help and and support necessary for living in family and in society. This goal will be accomplished by health care and other forms of help mentioned in the Mental Health Act and in the Social Help Act. Community-based model of psychiatric care is the key element of this system. Also, the Programme states desired accessibility rates for staff, number of beds and number of particular forms of psychiatric and alcohol treatment care. Separate rates for adult and children/youth population have been elaborated.
Adult↗
The medical model and psychiatric training.
The educational, sociologic and economic justifications for a recent decision to require an internship type of postgraduate experience in psychiatric training are discussed. There are many practical disadvantages to adding this requirement. Depending on the type of internship developed, such experiences may also impair rather than facilitate the trainee's progress as a clinician.
Attitude of Health Personnel↗
Use of private psychiatric services in Australia: an analysis of Medicare data.
An analysis of Medicare data for the 1985-86 financial year showed that the distribution of private psychiatric services varied greatly by age and sex. Females were greater users than males, except in childhood where the opposite was true. Service use was lowest for children and for the elderly and highest for the 35-44 year old group. Amongst patients receiving psychiatric services, elderly people were more likely to receive short consultations and ECT. These findings carry considerable implications for health service policy and for medical education.
Adolescent↗
The impact on utilization of a copayment increase for ambulatory psychiatric care.
The impact of a copayment increase on the utilization of psychiatric services in a prepaid group practice program is examined. Data are presented on utilization at the Columbia Medical Plan (Columbia, Maryland) two years before and two years after the copayment increase. There was a highly transient response to the increse in the copayment for psychiatric care. The year of the copayment increase was characterized by a small decline in the proportion of enrollees using psychiatric care, and a slight decrease in the utilization rate. These declines were short-lived, and utilization returned to previous levels one year after the copayment increase.
Deductibles and Coinsurance↗
Demographic and clinical characteristics of black psychiatric patients in a private general hospital.
A study of 419 first admissions to a private general hospital psychiatric inpatient unit showed that only 8.8 per cent were blacks, while 23 per cent of the population in the community were blacks. When compared to white patients, blacks were much less likely to be rerred for hospitalization by private sources, were substantially younger, and had shorter hospitalizations. The most common diagnosis for blacks was paranoid schizophrenia. The authors conclude that despite the widespread availability of third-party insurance coverage, blacks use the private general hospital less ofter than whites and their patterns of use are substantially different.
Adolescent↗