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PubMed1977

Accountability, public policy, and psychiatry.

The author identifies the direction of changes in health policy in the United States that need to be taken into account by the health professions in their dealings with government. She discusses three areas in which these changes will call for adjustment on the part of the medical profession and major health care institutions and defines the special challenge to psychiatry implicit in the changes. She concludes that the public's need for attention to the psychosocial aspects of health and the renewed interest in prevention present psychiatry with an opportunity to provide leadership in health care delivery.

Attitude of Health Personnel↗
PubMed1978

Utilization and cost of mental illness coverage in the Federal Employees Health Benefits Program, 1973.

The authors examine the utilization of mental illness benefits under the Blue Cross/Blue Shield and Aetna plans for federal employees; the latter plan sharply cut back its mental illness benefits in 1975. In 1973 mental illness benefits represented 7.4% of all payments under the Blues plan and 12% under the Aetna plan. The benefit for mental illness treatment under the Blues averaged $12.52 per person covered and was 7.3% of the total benefits for all conditions. Younger enrollees and their spouses tended to receive mental illness benefits primarily for outpatient treatment and children and older adults for hospitalization. These data raise key questions for claims review and peer review activities.

Adult↗
PubMed1978

Comparing clinic and private practice of psychiatry.

The author compared data on 2,020 cases treated by private psychiatrists with those on 2,052 cases treated by clinic psychiatrists in California. He also compared data on private treatment in California with those from a national survey of private psychiatrists. Private psychiatrists in California treated as many psychotic patients and used relatively brief psychotherapy about as often as clinic psychiatrists and were more likely to use hospitalization and to see patients individually. In comparison with the national sample, private psychiatrists in California treated more children and patients with situational disturbances and were more likely to receive payment from government sources.

California↗
PubMed1979

Standards affecting mental health care: a review and commentary.

The author describes the increasing focus on regulation and the standards applied to the field of mental health. He discusses four distinct but overlapping types of standards: 1) clinical, 2) practitioner, 3) program and facility, and 4) payment. He emphasizes the increasing influence of legislation and judicial decisions and points out several trends in standard setting affecting mental health care. Psychiatrists and other mental health practitioners are called on to take a larger role in shaping these standards to ensure that the quality of patient care is not compromised.

Accreditation↗
PubMed1979

Psychiatric malpractice: the California experience.

The cost of psychiatric malpractice insurance has increased dramatically in recent years. To shed light on the extent to which this increase is justified the author polled 133 California psychiatrists who had indicated experience with some form of claims activity over the past 5 years. The 107 respondents reported 105 cases, of which 57 (54%) resulted in no more than a notification of a possible claim, 22 (21%) did not proceed beyond legal deposition, 20 (19%) were settled by dollar payment before trial, and 6 (6%) were left to the courts. The author recommends tort reform and refinement of reported claim and loss data to contain the cost of malpractice insurance.

Adolescent↗
PubMed1980

Utilization of health and mental health services in a large insured population.

The authors analyzed 1975 data on the use of health and mental health services by the 2.3 million people covered by Michigan Blue Cross and Blue Shield. Only 4.6% of the covered population submitted hospital or physician claims for mental disorder; these people accounted for 7.3% of total hospital and physician charges for all health services in the covered population. According to the claims submitted, nonpsychiatric physicians saw almost half of all patients who were given a diagnosis of mental disorder, but psychiatrists accounted for the great bulk of mental health services and charges to these patients. High utilizers comprise a small proportion of all patients but account for a high proportion of charges for mental disorders and for all diagnoses.

Adolescent↗
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

Evaluating psychotherapy.

The authors analyze the possible need for a standing national group to evaluate the efficacy and safety of the psychotherapies. The current need is for a body whose function is more scientifically evaluative and less regulatory than the Food and Drug Administration because available psychotherapies are less specific in their beneficial effects and less dangerous than are drugs and because the practice of psychotherapy cannot be restricted entirely to the health professions. Even so, the authors believe the main criteria for discerning the boundaries between research and established practice are in principle at least as clear for psychotherapy as for other health interventions.

Consumer Behavior↗
PubMed1985

Reductions in coverage for mental and nervous illness in the Federal Employees Health Benefits Program, 1980-1984.

After nearly 15 years of nondiscriminatory coverage, the largest plan in the Federal Employees Health Benefits Program cut its coverage of care for mental illness disproportionately to coverage for other health care in 1981 and 1982. "Catastrophic" coverage for inpatient mental illness care was introduced by many of the plans in 1984. The authors review the reductions in coverage from economic and clinical perspectives, highlighting the impact of the disparity between the coverage for mental illness and other medical conditions. The model of catastrophic protection for treatment of mental illness set forth in the Federal Employees Health Benefits Program does not bode well for the patient and family who must cope with such a financial contingency.

Blue Cross Blue Shield Insurance Plans↗
PubMed1985

Fraud and abuse of government medical benefit programs by psychiatrists.

Government rosters of physicians suspended from the Medicare and Medicaid programs because of fraud and abuse indicate that psychiatrists form a disproportionately large segment of the total. Of the factors contributing to this situation, the most notable is that because psychiatrists charge for time rather than for services, they are more readily apprehended if they violate the rules. The authors speculate on whether in fact psychiatrists break the law more than physicians in other-specialties or whether the statistics are purely artifactual.

Crime↗
PubMed1985

Utilization and coverage of mental health services in health maintenance organizations.

Health maintenance organizations (HMOs) generally have very limited coverage of mental health care and have been charged with shortchanging chronic patients in the interests of economy. The authors analyzed 1979-1980 coverage and utilization data from 53 federally qualified HMOs. They found that while coverage is limited and very similar across the spectrum of HMOs, utilization rates vary greatly and do not correlate with extent of coverage. They suggest that management decisions may be critical in determining access to and use of mental health benefits in HMOs.

Ambulatory Care↗
PubMed1987

Effects of the new economic climate on psychotherapeutic practice.

Psychotherapy, especially the intensive variety, has been put under considerable adverse pressure by changes in the economics of medicine and psychiatry. The dominance of third-party rather than out-of-pocket payment for services raises questions about the "medicality," and thus the eligibility for coverage, of some disorders treated with psychotherapy. Trends toward the "industrialization" of psychiatry threaten to curtail the independent, fee-for-service conditions that may be necessary for psychotherapeutic practice. Efforts to reassert the medicality of psychotherapeutic psychiatry are essential, even though this will be difficult to accomplish and may have some limiting effects on coverage.

Diagnosis-Related Groups↗