PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Insurance, Psychiatric”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 469 records · Page 26Linked to original sources
PubMed1988

High users of outpatient mental health services, II: Implications for practice and policy.

Four assumptions underlie the stereotyped view of use of outpatient mental health services: 1) all use is alike, 2) any use leads to high use, 3) all high use is discretionary, and 4) insurance encourages excessive use. The authors refute the first three assumptions and suggest that different types of treatment episodes vary in their responsiveness to price. Diagnosis appears to be a poor indicator of inpatient needs; some coverage limits outpatient benefits according to type of treatment. The authors favor a combination of pricing strategies, as well as case management and clinical review for high users, which would not impede initial treatment but would limit excessive use of mental health services.

Ambulatory Care↗
PubMed1988

Reimbursement for partial hospitalization: a survey and policy implications.

Lack of third-party reimbursement is frequently cited as a cause of underutilization of partial hospitalization. The authors contacted a sample of health maintenance organizations (HMOs) and public and private payers to obtain information about their payment policies. They conclude that in the private sector, reimbursement barriers are diminishing but that clinicians frequently must obtain an extracontractual agreement for coverage. Partial hospitalization is particularly attractive to HMOs and others that pay on a capitated basis and can strictly control utilization. A recent clarification of Medicare guidelines may facilitate reimbursement for hospital-based programs, but there remain significant disincentives under the Medicare statute for widespread utilization of partial hospitalization.

Ambulatory Care↗
PubMed1988

How to survive in the private practice of psychiatry.

The private practice of psychiatry is being transformed by the new economics of medical care. Patients are paying more out-of-pocket for necessary care (demand-side cost sharing), and health care providers are being asked to assume part of the risk of treatment through prospective payment (supply-side cost sharing). Specific survival strategies for psychiatrists in private practice include development of a balanced practice, expansion of referral networks, participation in alternative delivery systems such as health maintenance organizations and preferred provider organizations, active involvement in utilization and claims review, participation in outcome studies, and expansion of patient care advocacy and community involvement.

Health Maintenance Organizations↗
PubMed1991

A psychodynamic perspective on the clinical impact of insurance review.

The rise of managed care and concurrent utilization review has had a profound impact on the practice of inpatient psychiatry. Little has been written, however, on the clinical impact of the review process itself. The actions of insurance reviewers often result in their being incorporated into the psychopathology of individual patients and into the dynamics of families and institutional settings. The authors apply psychodynamic understanding to a series of case examples to illustrate how concurrent review may promote splitting, impede the patient's ability to separate from the hospital, and paradoxically reinforce the patient's illness. They also explore a number of typical responses of treatment staff and families to the review process. A case vignette demonstrating a sincere effort at mutual collaboration between payers and providers is also presented. This spirit of compromise is proposed as the solution that best serves patient care.

Adolescent↗
PubMed1992

The cost-effectiveness of psychotherapy: a plan for research.

The authors assess gaps in the current knowledge base on psychotherapy research and the cost-effectiveness of psychotherapy. Despite the considerable and increasingly sophisticated body of research on the efficacy of psychotherapy, there is an alarming paucity of studies focusing on the cost-effectiveness of psychotherapy. This problem is particularly evident in the absence of studies exploring nonclinical effects of treatment and the broader range of domains in which intervention may have an impact. Initiation of research on the cost-effectiveness of psychotherapy is important for ensuring good clinical practice and data-based policy formulation. What is needed is greater specificity regarding the populations and problems for which psychotherapy can provide the greatest benefits, identification of the variables, measures, and methodological approaches that are most useful in yielding these important data, and comprehensive quantification of the costs and effects of psychotherapy.

Ambulatory Care↗
PubMed1994

Use of minor tranquilizers and antidepressant medications by depressed outpatients: results from the medical outcomes study.

OBJECTIVE: The purpose of this study was to compare use of minor tranquilizers and antidepressant medications by depressed outpatients across different treatment settings. METHOD: The study subjects were 634 patients with current depressive disorder or depressive symptoms who visited general medical clinicians, psychiatrists, psychologists, or other therapists. Data on use of medication in different types of clinical practices with different types of payment plans were gathered from structured interviews by study clinicians and from surveys of patients. RESULTS: Of the depressed patients, 23% had recently used an antidepressant medication and 30% had used a minor tranquilizer. The level of use was similar for different types of depression. Patients of psychiatrists were the most likely to use medications. In the practices of physicians, but not nonphysicians, the more severely distressed patients were more likely to use antidepressant medications. Of the patients taking an antidepressant medication, 39% used an inappropriately low dose. Patients in prepaid health care plans were twice as likely as those in fee-for-service care to use minor tranquilizers. CONCLUSIONS: Less than one-third of the depressed outpatients used antidepressant medications, and the probability of use was similar for major depression and other types of depression for which efficacy is less well established. Use of antidepressant medications among patients of nonphysicians was unrelated to the level of psychological sickness, suggesting the need for more cooperation among provider groups. Minor tranquilizers were used more often than antidepressants, particularly among patients in prepaid plans, despite controversy over their efficacy.

Adult↗
PubMed1994

Outpatient psychotherapy in the United States, I: Volume, costs, and user characteristics.

OBJECTIVE: This article provides an overview of the volume, composition, and costs of outpatient psychotherapy in the United States. METHOD: Data were analyzed from the household section of the 1987 National Medical Expenditure Survey. The authors determined the volume and distribution of psychotherapy visits by provider specialty, setting, source of expenditure, and reason for visit. An examination was made of the demographic characteristics, health status, and mental health utilization profile of psychotherapy users. RESULTS: In 1987, Americans made 79.5 million outpatient psychotherapy visits at a total cost of $4.2 billion. Most of these visits were to mental health specialists (more than 80%) and were reported to be for the treatment of mental health conditions (63.5%). However, psychotherapy was not provided in a substantial proportion of the visits to mental health specialists (21.1%) or the visits to treat mental conditions (29.8%). Separated and divorced persons, females, whites persons aged 35 to 49 years, and those with more than 15 years of education had a greater likelihood of using psychotherapy. Psychotherapy use was also greater among persons in poor general health and those reporting health-related functional impairments. General medical costs of psychotherapy users exceeded those of nonusers. CONCLUSIONS: Psychotherapy accounts for approximately 8% of outpatient medical care costs. Users of psychotherapy appear to be more distressed than is commonly assumed: they report poorer general health, higher general medical costs, and more functional impairment than nonusers. Although mental health specialists commonly provide psychotherapy to treat mental disorders, all mental health care is not psychotherapy.

Adolescent↗
PubMed1998

Relationship between type of insurance and care during the early course of psychosis.

OBJECTIVE: Little is known about the relationship between insurance and care in the early course of psychosis. This study explored the insurance status of first-admission psychotic patients and the relationship between type of insurance and care received up to this admission. METHOD: Data are from the Suffolk County Mental Health Project, an epidemiologic study of first-admission psychosis. Data on insurance status (N=525) were pooled from hospital records, respondents, and significant others. Logistic regression analysis, controlling for key background variables and diagnosis, was used to study the relationship between insurance and care. RESULTS: At first admission, 233 (44%) of the patients had no insurance, 78 (15%) had Medicaid or Medicare, 203 (39%) had private insurance, eight (1.5%) were insured by the Veterans Administration, and the insurance status of three (1.5%) was unknown. Having private insurance increased the likelihood of having received previous mental health treatment (psychotherapy specifically), being admitted voluntarily, being hospitalized in a community hospital rather than a public hospital, and being hospitalized within 3 months of onset of psychosis. Having Medicaid/Medicare increased the likelihood of receiving nonantipsychotic medication before this hospitalization, admission to a community hospital rather than a public hospital, having received previous mental health treatment in general, and voluntary admission. CONCLUSIONS: During the early course of psychotic illness, many people lack any type of health insurance, and this is associated with a decreased likelihood of obtaining care before their first hospital admission.

Adult↗
PubMed1998

Mental disorders and access to medical care in the United States.

OBJECTIVE: The authors examined the barriers to receipt of medical services among people reporting mental disorders in a representative sample of U.S. adults. METHOD: The sample was drawn from adults who responded to the 1994 National Health Interview Survey (N=77,183). The authors studied the association between report of a mental disorder and 1) access to health insurance and a primary provider, and 2) actual receipt of medical care. Multivariate techniques were used to model problems with access as a function of mental disorders, controlling for demographic, insurance, and health variables. RESULTS: While people who reported mental disorders showed no difference from those without mental disorders in likelihood of being uninsured or of having a primary care provider, they were twice as likely to report having been denied insurance because of a preexisting condition or having stayed in their job for fear of losing their health benefits. Among respondents with insurance, those who reported mental illness were no less likely to have a primary care provider but were about two times more likely to report having delayed seeking needed medical care because of cost or having been unable to obtain needed medical care. CONCLUSIONS: People who reported mental disorders experienced significant barriers to receipt of medical care. Efforts to measure and improve access to health care for this population may need to go beyond simply providing insurance benefits or access to general medical providers.

Adult↗
PubMed1998

Physical health, depressive symptoms, and managed care enrollment.

OBJECTIVE: This study used a national employee survey to test the hypothesis that symptomatic individuals in general, and individuals with depressive symptoms in particular, are disproportionately enrolled in fee-for-service health care plans as compared to health maintenance organizations (HMOs). METHOD: The study analyzed data from the 1993 Employee Health Care Value Survey, a questionnaire distributed to employees of three large corporations. The sample comprised 20,283 employees covering six U.S. geographic regions and 46 health plans. The authors used logistic regression to model the association between HMO enrollment and presence of physical and depressive symptoms, measured by subscales derived from the Medical Outcomes Study 36-item Short-Form Health Survey, adjusting for health, demographic, and insurance variables. RESULTS: In unadjusted models, enrollees in fee-for-service plans had higher rates of both depressive and physical symptoms than HMO enrollees. After adjustment for age alone or for age and other potential confounders, there was no difference in physical symptoms between plan types. However, individuals with high levels of depressive symptoms were 16% less likely to be enrolled in HMOs than in fee-for-service plans after adjustment for age, other demographic variables, physical health status, and insurance characteristics. CONCLUSIONS: This study provides evidence that symptomatic individuals are more likely to be enrolled in fee-for-service plans than in HMOs. While much of the effect for physical symptoms may be explained by differences in demographic variables, particularly age, the difference in depressive symptoms appears to be independent of those variables.

Adult↗
PubMed2006

Psychiatric employment evaluations and theHealth Insurance Portability and Accountability Act.

This review was intended to familiarize psychiatrists with the implications of the Health Insurance Portability and Accountability Act of 1996 on the provision of third-party employment evaluations. Understanding the provisions of the act relative to third-party evaluations can assist psychiatrists in avoiding some of the conflicts that arise in performing such evaluations.

Adolescent↗
PubMed2000

Treatment for depression following the 1996 National Depression Screening Day.

OBJECTIVE: Characteristics of the subsequent treatment received by people who screened positive for depression in the 1996 National Depression Screening Day were investigated. METHOD: A follow-up telephone survey was completed by 1,502 randomly selected participants from 2,800 sites. RESULTS: Of 927 people for whom additional evaluation was recommended, 602 (64.9%) obtained evaluations and 503 (83.6%) received treatment. Of these 503, 260 (51.7%) received psychotherapy and medication, 130 (25.8%) received medication only, and 93 (18.5%) received psychotherapy only. Compared with people without health or mental health insurance, individuals with health insurance (66.7% versus 57.5%) and mental health insurance (74.6% versus 55.3%) were more likely to comply with the recommendation to obtain follow-up evaluation. CONCLUSIONS: One-half of the people treated for depression received a combination of psychotherapy and medication. Lack of insurance was associated with not following the recommendation to obtain further evaluation and treatment.

Adolescent↗
PubMed2000

Barriers to the treatment of social anxiety.

OBJECTIVE: This article evaluates barriers to treatment reported by adults with social anxiety who participated in the 1996 National Anxiety Disorders Screening Day. METHOD: The background characteristics of screening day participants with symptoms of social anxiety (N=6,130) were compared with those of participants without social anxiety (N=4,507). Barriers to previous mental health treatment reported by participants with and without symptoms of social anxiety were compared. RESULTS: Social anxiety was strongly associated with functional impairment, feelings of social isolation, and suicidal ideation. Compared to participants without social anxiety, those with social anxiety were significantly more likely to report that financial barriers, uncertainty over where to go for help, and fear of what others might think or say prevented them from seeking treatment. However, they were significantly less likely to report they avoided treatment because they did not believe they had an anxiety disorder. Roughly one-third (N=1,400 of 3,682, 38.0%) of the participants with symptoms of social anxiety who were referred for further evaluation were specifically referred for an evaluation for social phobia. CONCLUSIONS: Social anxiety is associated with a distinct pattern of treatment barriers. Treatment access may be improved by building public awareness of locally available services, easing the psychological and financial burden of entering treatment, and increasing health care professionals' awareness of its clinical significance.

Adult↗