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At least 19 recordsLinked to original sources
PubMed2001

Are publicly-insured psychiatric outpatients in Japan satisfied?

Japan has a government financed outpatient program for people with mental disorders, called the 'publicly-insured' program. This study was performed to examine whether the target patient population used this publicly-insured program properly and to compare the degree of satisfaction of publicly-insured psychiatric outpatients with generally-insured psychiatric outpatients. The characteristics and satisfaction of 97 (43.9%) publicly-insured psychiatric outpatients and 124 (55.1%) generally-insured outpatients in Japan were studied. Psychiatrists rated sociodemographic and diagnostic information and patients were asked to complete the Japanese version of Client Satisfaction Questionnaire (CSQ-8J). The publicly-insured were longer-term and lower functioning patients and were significantly more dissatisfied with the services they received than the generally-insured patients. The publicly-insured program was successful in that patients with lower functioning (the primary target population of this program) were cared for and because they received treatment for longer periods of time. However, the program does not sufficiently satisfy the consumers of the services, despite its high costs. In this respect, this program needs to focus more on patients' points of view. More information on programs their enrollment procedures for patients may be helpful in educating consumers and citizens, clarifying expectations of services, and in influencing satisfaction.

Adult↗
PubMed1983

Problems in private psychiatric insurance.

Insurance coverage for hospitalization in a freestanding psychiatric facility faces challenging, but not insurmountable, difficulties currently and in the immediate future. Relevant issues include: possible reductions in health insurance tax deductibility, so-called "consumer choice" and "pro-competition" options, prospective financing, and cost shifting from government insurance onto private patients. Some problems more specific to private psychiatric hospitals include: misuse of insurance coverage for dubious "therapies," the effects of declining coverage, the "dental versus mental" conflict, the effect of non-physicians entering the provider pool, poor coverage for liaison and consultation psychiatry, inappropriate usage, and confidentiality concerns. Positive future possibilities include: implementation of government insurance programs through private sector contracts, continuing improvement in psychiatric scientific technology, increased accountability efforts, public education, and improvements in psychiatry's relationships with labor and management.

Cost Allocation↗
PubMed1982

Federal Employees' experience as a guide to the cost of insuring psychiatric services in the various states.

The two largest plans in the Federal Employees Health Benefits Program-Blue Cross and Blue Shield and Aetna - have reported benefit payments and the number of people who have used psychiatric services on a state-by-state basis for two decades. The author translates this experience into per capita utilization rates in a constant dollar terms and compares the benefit costs of the two plants over a 4-year period (1976-1979). Within each state, utilization rates did not change much over the 4 years, and the rank ordering among states by rate of utilization was quite similar for both plants. The author believes that the consistency noted can be useful in estimating costs of psychiatric coverage at the state level.

Blue Cross Blue Shield Insurance Plans↗
PubMed1998

Do treatment restrictions imposed by utilization management increase the likelihood of readmission for psychiatric patients?

OBJECTIVES: The use of utilization management as a cost-containment strategy has led to debate and controversy within the field of mental health. Little is currently known about how this cost-containment approach affects patient care or quality. The aim of this investigation was to determine whether treatment restrictions imposed on privately insured psychiatric patients by a utilization management program affected the likelihood of readmission. METHODS: The utilization management program included three review activities: preadmission certification, concurrent review, and case management. During a 5-year period (1989-1993), 3,073 inpatient reviews were performed on 2,443 privately insured psychiatric patients. Using logistic regression, restrictions imposed by utilization management on length-of-stay in relation to 60-day readmission rates were investigated. RESULTS: The most common diagnoses among the psychiatric patients whose care was reviewed were alcohol dependence (22.9%), recurrent depression (22.5%), and single-event depression (20.8%). On average, 22.4 days of inpatient psychiatric treatment was requested through the review procedures, and 15.5 days of care were approved by the utilization management program. Of the 2,443 patients reviewed, 7.9% had a readmission within 60 days of their initial admission. Patients whose length-of-stay was restricted by utilization management were more likely to be readmitted. For each day that the requested length-of-stay was reduced, the adjusted odds of readmission within 60 days increased by 3.1% (P = 0.004). CONCLUSIONS: The utilization management program restricted access to inpatient psychiatric care by limiting length of stay. Although this approach may promote cost containment, it also appears to increase the risk of early readmission. Continuing attention should be paid to investigating the effects on quality of utilization management programs aimed at containing mental health costs.

Adult↗
PubMed1983

Psychiatric benefits and insurance regulation in Massachusetts: a national model?

The Massachusetts Mandatory Mental Health Insurance Act requires all health insurance plans in the state to cover mental illness. Because of their concerns that this law might be taken as a national model, the authors describe the problems encountered in implementing it and the conflicts between the insurance carriers and psychiatry. The authors attribute the problems to some insurance carriers' failure to deal directly with organized psychiatry in obtaining screening guidelines, the absence of psychiatrists on the carriers' central committees, and psychiatrists' generally indifferent and hostile attitudes toward the carriers. The authors describe recent improvements and recommendations based on 10 years of experience.

Attitude of Health Personnel↗