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At least 307 records · Page 17Linked to original sources
PubMed1985

Use of outpatient somatic health services by patients who use or need mental health services in three provider plans.

A major topic in mental health (MH) research addresses the problem that patients who use mental health services have inappropriately high levels of somatic use, and examines whether provision of mental health services can decrease the inappropriate use (the so-called offset effect). However, the research showing higher somatic use by mental health patients has usually been unable to control for the patients' health status, or for their mental health status. In this paper we examine use of somatic health services by enrollees in three provider plans as a function of both mental health use and mental health need. In two of the provider plans (an HMO and a prepaid independent practice association), MH users used significantly more outpatient somatic services than non-MH patients, after control for age and sex, and after control for the number of chronic conditions they had. People with MH need, however, did not use significantly more MH services than those without MH need. In the third plan, a Blue Cross/Blue Shield type of plan, results were different; MH users did not have significantly higher somatic utilization after control for chronic conditions, and those with MH need did have significantly higher somatic utilization after control for age and sex, but not after control for the number of chronic conditions. These results suggest that the form of inappropriate use of outpatient somatic services, and the nature of an offset effect, may be specific to the type of insurance provided.

Adult↗
PubMed1988

E pluribus unum: striking back at disunity.

Examination of the current tendency to emphasize differences in psychiatry leads to the conclusion that there is a vast distance between those differences offering diversity and controversy that enliven and enlighten our professional lives and those born out of personal pique and intellectual obsolescence. For while diversity is essential and controversy invigorating--ideological sniping at one another is destructive, and being behind the times, downright dangerous. The title of may paper--"E Pluribus Unum"--roughly translated means "out of the many--one." It is my contention that sometimes we perceive the differing views of psychiatry as splitting us apart and destroying us, and indeed when they involve sniping and obsolescence, this may be the case. Such a view of each other is, I believe, increasing because of increasing environmental changes--in science, in corporatization, in reimbursement, and in competition. But I believe equally firmly that the solution to these changes lies in our hanging together and conducting effective, cooperative, educational, political action, and ethical activities, rather than cursing either the darkness or each other. Thus, while many wish to emphasize differences, I wish to conclude by emphasizing similarities. We are many, and that diversity and the controversy it engenders is a source of enormous strength. But we are also one, and that identity and cohesiveness can dispel the more destructive types of differences. We must make sure that we remain many, but we must make equally sure that we remain one.

Humans↗
PubMed1976

Social class and group therapy in a working class population.

In a clinic in which the assignment of patients to therapy was demonstrated as not affected by social class and in which no patient was excluded as unsuitable, 45% of those referred to group therapy stayed 2 or more years. The only category that consistently correlated with not remaining in treatment was that of unemployment. When unemployed persons were included there appeared to be a significant correlation between a stay of 2 or more years and social class. When only employed persons were considered, this significance disappeared.

Adolescent↗
PubMed1977

Possible programmatic consequences of community mental health center funding arrangements: illustrations based on inpatient utilization data.

Funding arrangements have a direct and substantial influential effect on the delivery of mental health services. Despite the original intent of the community mental health center philosophy, centers have not been freed from programmatic limitations imposed by the fiscal systems. The focus of this article is the inpatient unit that has the key role as relates to a center's ability to raise revenue. Using data from a study of community mental health center inpatient utilization patterns, the authors demonstrate that centers face the problem of becoming revolving doors (for a recidivist population). Existing fiscal arrangements, it is suggested, reinforce this pattern and tend to downplay innovative alternatives to traditional inpatient care.

Ambulatory Care↗
PubMed1997

Carving-out mental health benefits to Medicaid beneficiaries: a shift toward managed care.

Several states have designed and implemented innovative programs for Medicaid beneficiaries that carve-out the provision of mental health from general health care. This paper describes several such programs and outlines the choices states face in designing these services. Major decisions include the selection of a public or private agency, how that agency is chosen, reimbursement schemes, eligibility criteria, and benefits to be covered. While carve-out programs have yielded initial savings, more research is needed on their effect on quality of care and general health care costs.

Contract Services↗
PubMed2001

Toward a national consumer survey: evaluation of the CABHS and MHSIP instruments.

This article describes a study evaluating the Consumer Assessment of Behavioral Health Survey (CABHS) and the Mental Health Statistics Improvement Program (MHSIP) surveys. The purpose of the study was to provide data that could be used to develop recommendations for an improved instrument. Subjects were 3,443 adults in six behavioral health plans. The surveys did not differ significantly in response rate or consumer burden. Both surveys reliably assessed access to treatment and aspects of appropriateness and quality. The CABHS survey reliably assessed features of the insurance plan; the MHSIP survey reliably assessed treatment outcome. Analyses of comparable items suggested which survey items had greater validity. Results are discussed in terms of consistency with earlier research using these and other consumer surveys. Implications and recommendations for survey development, quality improvement, and national policy initiatives to evaluate health plan performance are presented.

Adult↗
PubMed2002

The influence of patient characteristics on ratings of managed behavioral health care.

Despite current emphasis on consumer-based performance measures, little is known about factors that influence consumer ratings of behavioral health care. This study examines the influence of patient characteristics, health care use, and insurance coverage on patients' ratings of their managed behavioral health care in both commercial and public plans. Older and healthier patients rated their behavioral health care and health plan more highly than did other patients. Patients with less education and those whose insurance paid all costs of care gave consistently higher plan ratings. Women and frequent users enrolled in commercial plans gave more positive care ratings. After adjusting for enrollee characteristics and coverage, there were no differences between ratings of patients in commercial and public plans. These results are consistent with other research that illustrates the importance of adjusting health care ratings for patient characteristics when comparing plans.

Adolescent↗