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PubMed1991

Typical patterns and cost of alcoholism treatment across a variety of populations and providers.

This paper presents data on the utilization of alcoholism treatment services in three populations of insurance enrollees: enrollees covered by the insurance plan of a large midwestern manufacturing firm, 1981-1987 (N = 1.425); enrollees of the California Health Insurance Plan of the Public Employees Retirement System, 1974-1976 (N = 766); U.S. government civilian employees enrolled with the Aetna Insurance Company, 1980-1983 (N = 1,697). The average age of the treated alcoholics in these three groups ranged from 37 to 51. Between two-thirds and three-quarters were male. Inpatient alcoholism treatment services were more frequently used than outpatient, with inpatient admissions averaging between 1.2 and 1.5 per person. For enrollees of the midwestern manufacturing firm, total alcoholism treatment costs averaged $4,665 per person (December 1985 dollars). The influence of insurance plan coverage and other factors on utilization patterns is discussed.

Adult↗
PubMed1994

Local factors affecting the tendency to bypass local hospitals for inpatient mental health care: an exploratory analysis.

Using the records of 2,171 rural residents of Illinois who received inpatient treatment for mental illness or substance abuse, this paper examines factors that influence the tendency to seek service from a distant rather than a local hospital. Results indicate that the age and insurance coverage of the individual, the per capita income of the community area, surrogates for the service orientation of the local hospital and the proximity of the patient's residence to an urban center are significant influences. With the exceptions of drug abuse requiring detoxification or other symptomatic treatment, drug abuse accompanied by comorbidity and psychosocial disorders, psychosis, and childhood disorders, the primary diagnosis of the individual failed to have a significant effect on the propensity to bypass local sources of inpatient treatment.

Adult↗
PubMed1986

Community mental health services in transition: who is benefiting?

This study addresses four major questions about the delivery of community-based mental health services: Which target groups are benefiting from recent policy shifts? What services are expanding? What staffing changes are occurring? How are these changes being financed? Findings indicate that state policies are aiding chronically mentally ill clients, but that services for other important target groups are being reduced substantially.

Adolescent↗
PubMed1988

Financing outpatient mental health care: how much does insurance actually help?

Providers of mental health services in both public and private sectors are becoming increasingly dependent on third-party health insurance to cover the costs of outpatient psychotherapy. The present investigation examines reimbursement rates for the cost of the average course of psychotherapy for a sample of industries in one city. Results suggest that insurance coverage should not be viewed as a panacea by mental health providers.

Community Mental Health Services↗
PubMed1992

Improving psychotherapy services: applications of research, audit and evaluation.

Psychotherapy services face increasing demand but are vulnerable to critical scrutiny by service purchasers seeking evidence of cost-effectiveness. Psychotherapy research, although it can benefit practitioners, cannot adequately address these concerns because of poor external validity and it is argued that complementary strategies are needed. A number of service-based evaluative methods are reviewed and the distinctions clarified between service evaluation, operational research, professional audit, service audit, quality assurance and total quality management. Maxwell's (1984) six category framework is used to examine a number of issues in psychotherapy services including the assessment process, treatment-of-choice decisions, predicting negative effects of treatment, dose-response in psychotherapy, brief interventions, therapist competence, clinical significance, cost effectiveness and measures of psychotherapy service inputs, process and outcomes. This review advocates reflective practice within a self-evaluating psychotherapy service and a systemic approach which can take account of the perspectives of patients, purchasers, service managers, referrers and practitioners.

Follow-Up Studies↗
PubMed2004

Ethical issues of cost effectiveness analysis and guideline setting in mental health care.

This article discusses ethical issues which are raised as a result of the introduction of economic evidence in mental health care in order to rationalise clinical practice. Cost effectiveness studies and guidelines based on such studies are often seen as impartial, neutral instruments which try to reduce the influence of non-scientific factors. However, such rationalising instruments often hide normative assumptions about the goals of treatment, the selection of treatments, the role of the patient, and the just distribution of scarce resources. These issues are dealt with in the context of increased control over clinical practice by third parties. In particular, health insurers have a great interest in economic evidence in clinical care settings in order to control access to and quality of (mental) health care. The authors conclude that guideline setting and cost effectiveness analysis may be seen as important instruments for making choices in health care, including mental health care, but that such an approach should always go hand in hand with a social and political debate about the goals of medicine and (mental) health care. This article is partly based on the results of a research project on the normative aspects of guideline setting in psychiatry and cardiology which was conducted under the guidance of the Royal Dutch Medical Association.

Angina Pectoris↗
PubMed2002

Mental health insurance claims among spouses of frequent business travellers.

OBJECTIVES: Following up on two earlier publications showing increased psychological stress and psychosocial effects of travel on the business travellers this study investigated the health of spouses of business travellers. METHODS: Medical claims of spouses of Washington DC World Bank staff participating in the medical insurance programme in 1997-8 were reviewed. Only the first of each diagnosis with the ninth revision of the international classification of diseases (ICD-9) recorded for each person was included in this analysis. The claims were grouped into 28 diagnostic categories and subcategories. RESULTS: There were almost twice as many women as men among the 4630 identified spouses. Overall, male and female spouses of travellers filed claims for medical treatment at about a 16% higher rate than spouses of non-travellers. As hypothesised, a higher rate for psychological treatment was found in the spouses of international business travellers compared with non-travellers (men standardised rate ratios (RR)=1.55; women RR=1.37). For stress related psychological disorders the rates tripled for both female and male spouses of frequent travellers (>or= four missions/year) compared with those of non-travelling employees. An increased rate of claims among spouses of travellers versus non-travellers was also found for treatment for certain other diagnostic groups. Of these, diseases of the skin (men RR=2.93; women RR=1.41) and intestinal diseases (men RR=1.31; women RR=1.47) may have some association with the spouses' travel, whereas others, such as malignant neoplasms (men RR=1.97; women RR=0.79) are less likely to have such a relation. CONCLUSION: The previously identified pattern of increased psychological disorders among business travellers is mirrored among their spouses. This finding underscores the permeable boundary between family relations and working life which earlier studies suggested, and it emphasises the need for concern within institutions and strategies for prevention.

Adult↗
PubMed2007

Managed behavioral health care carve-outs: past performance and future prospects.

As the managed behavioral health care market has matured, behavioral health carve-outs have solved many problems facing the delivery of behavioral health services; at the same time, they have exacerbated existing difficulties or created new problems. Carve-outs developed to address rising inpatient behavioral health costs and limited insurance coverage. They are based on the economic principles of economies of specialization, economies of scale, price negotiation, and selection. Literature shows that carve-outs have been successful in lowering costs and maintaining or improving access, but results on their impact on quality of care are mixed. In recent years, carve-outs have evolved to take on new roles within the health system, such as coordinating mental and physical health, addressing fragmented public financing systems, and using market power to implement quality improvement. Although not perfect, carve-outs have been instrumental in addressing long-standing challenges in utilization, access, and cost of behavioral health care.

Behavioral Medicine↗