Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Insurance, Psychiatric”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

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

At least 289 records · Page 16Linked to original sources
PubMed1985

Costs of mandates for outpatient mental health care in private health insurance.

Various methods for estimating the cost of mandated mental health benefits have been devised, each resulting in substantially different estimates. These methods neglect to distinguish between the two components of cost to the insurer: social cost (due to increased utilization) and shifted cost (from other sources of payment). We apply a method we developed for estimating the two types of costs of mandates for outpatient mental health services that integrates data from insurers with information from the literature on financing of mental health services. We applied our method to legislation recently proposed in Massachusetts that would double the mandated minimum benefit level from +500 to +1,000. We expect payments by the largest carrier in the state to increase by a factor of 1.65. More than half of this increase represents shifted costs rather than new costs to society.

Ambulatory Care↗
PubMed1989

A market analysis comparing the practices of psychiatrists and psychologists.

Data are analyzed that describe the clinical work of representative samples of psychiatrists and clinical psychologists who practiced in one of 62 markets for mental health services in the United States during 1982 and 1983. For psychiatrists, intensity of treatment (ie, mean face-to-face treatment minutes per patient per month) varied from 107 to 368 minutes vs 124 to 283 minutes for psychologists. Multiple regression models explain these variations somewhat differently for each provider group. Whereas the patient's severity or stage of illness is explanatory for both psychiatrists and psychologists, only psychologists appear to alter intensity of treatment in response to local economic conditions. Psychiatrists have large diversified practices, whereas psychologists tend to treat fewer persons and the bulk of these have less severe mental and emotional conditions. Neither practitioner group appeared to provide services in excess of their perceptions of patient need. These and other important similarities and differences are explored, and the advantages of local market focus for examining relevant public policy issues are discussed.

Female↗
PubMed1996

Medical costs attributed to depression among patients with a history of high medical expenses in a health maintenance organization.

BACKGROUND: While previous studies have compared medical utilization between depressed and nondepressed patients, we conducted a study that focused specifically on patients who had a history of high medical expenditures. METHODS: This study was designed to determine whether a positive screen for depression is predictive of continued high medical expenditures. Medical utilization data were obtained on 50,000 patients enrolled in the DeanCare health maintenance organization for 2 consecutive years. Consistent high utilizers were identified based on the medical utilization costs (paid by the health maintenance organization) for those 2 consecutive years, 1992 and 1993. A depression screen based on the Medical Outcomes Survey was mailed to 786 high utilizers. Their costs were determined for 1994. Regression analyses identified 1994 costs associated with depression, adjusting for age, sex, benefits package, and medical comorbidity. RESULTS: Depressed high utilizers were more likely than nondepressed high utilizers to have higher medical costs in 1994. Among high utilizers, depressed patients' 1994 costs were significantly higher ($5764 vs $4227; P < .001), although expenditures for depressed and nondepressed high utilizers were similar for the previous 2 years. The total medical cost associated with depression in 1994, adjusted for age, sex, benefits package, and medical comorbidity, was $1498 per patient. CONCLUSIONS: In the third year (1994), a positive Medical Outcomes Survey screen for depression in high utilizers was associated with $1498 in higher medical costs. The average actual amount spent on depression treatment accounted for only a small portion of total medical costs for depressed high utilizers in the third year.

Age Factors↗
PubMed1996

Counseling typically provided for depression. Role of clinician specialty and payment system.

BACKGROUND: To assess how current policy trends may affect the use of counseling for depression, we examined the variation in the use of counseling and usual clinician counseling style for depression across specialty sectors (psychiatry, psychology, and general medicine) and reimbursement type (fee-for-service or prepaid). METHODS: Three types of observational data from the RAND Medical Outcomes Study: (1) patient-reported demographics, depressive symptoms, clinical status, and perceptions about participation style; (2) clinician reports of counseling during specific patient encounters; and (3) clinician reports of the usual counseling and interpersonal style across patients who were seen in a practice. RESULTS: While almost all depressed patients who were being treated by mental health specialists received brief counseling for at least 3 minutes, less than half of the depressed patients in the general medical sector received such counseling--even for those patients with a current depressive disorder. Counseling rates were lower under prepaid than fee-for-service care in general medical practices. Psychiatrists relied more on psychodynamic approaches, and psychologists relied more on behavioral therapies relative to each other, but both specialty groups provided longer sessions and used more formal psychotherapeutic techniques (e.g., interpretation) than did general medical clinicians. Clinicians who were treating more patients who had prepaid plans reported a lower proclivity for face-to-face counseling, and they spent less time when they were counseling patients compared with clinician who were treating more patients who had fee-for-service plans; however, these differences were not large. CONCLUSION: The use of counseling in the usual care for depression varied by both specialty and payment system, while the usual clinician counseling style differed markedly by specialty, but only slightly by payment system.

Adult↗
PubMed1996

Some economics of mental health 'carve-outs'.

We discuss the rationale for benefit carve-out contracts in general and for mental health and substance abuse in particular. We focus on the control of adverse selection as a principal explanation and find that this is consistent with the wide-spread use of sole-source contracting with periodic rebidding. We also find that some degree of risk sharing is common; we interpret this as a method of balancing cost-containment incentives with incentives to maintain access and quality on unmeasured dimensions.

Capitation Fee↗
PubMed2006

Long-term effectiveness and cost of a systematic care program for bipolar disorder.

CONTEXT: Despite the availability of efficacious treatments, the long-term course of bipolar disorder is often unfavorable. OBJECTIVE: To test the effectiveness of a multicomponent intervention program to improve the quality of care and long-term outcomes for persons with bipolar disorder. DESIGN: Randomized controlled trial with allocation concealment and blinded outcome assessment. SETTING: Mental health clinics of a group-model prepaid health plan. PATIENTS: Of 785 patients in treatment for bipolar disorder who were invited to participate, 509 attended an evaluation appointment, 450 were found eligible to participate, and 441 enrolled in the trial. INTERVENTIONS: Participants were randomly assigned to a multicomponent intervention program or to continued care as usual. Three nurse care managers provided a 2-year systematic intervention program, including the following: a structured group psychoeducational program, monthly telephone monitoring of mood symptoms and medication adherence, feedback to treating mental health providers, facilitation of appropriate follow-up care, and as-needed outreach and crisis intervention. MAIN OUTCOME MEASURES: In-person blinded research interviews every 3 months assessed mood symptoms using the Longitudinal Interval Follow-up Examination. Health plan administrative records were used to assess the use and cost of mental health services. RESULTS: Intent-to-treat analyses demonstrated that the intervention significantly reduced the mean level of mania symptoms (z = 2.09, P = .04) and the time with significant mania symptoms (19.2 vs 24.7 weeks; F(1) = 6.0, P = .01). There was no significant intervention effect on mean level of depressive symptoms (z = 0.19, P = .85) or time with significant depressive symptoms (47.6 vs 50.7 weeks; F(1) = 0.56, P = .45). Benefits of the intervention were found only in a subgroup of 343 persons with clinically significant mood symptoms at the baseline assessment. The incremental cost (adjusted) of the intervention was 1251 dollars (95% confidence interval, 55-2446 dollars), including approximately 800 dollars for the intervention program services and an approximate 500 dollars increase in the costs of other mental health services. CONCLUSIONS: Population-based systematic care programs can significantly reduce the frequency and severity of mania in bipolar disorder, and cost increases are modest considering the clinical gains. The incorporation of more specific cognitive and behavioral content or more effective medication regimens may be necessary to significantly reduce the symptoms of depression.

Adult↗
PubMed1998

Substitution of physicians and other providers in outpatient mental health care.

This paper evaluates the extent to which patients may substitute physician and non-physician outpatient mental health services in response to insurance coverage which differs by provider type. Using data from the National Medical Expenditure Survey, a semi-flexible two-stage demand specification is used to estimate substitution elasticities. Our results indicate that insurance coverage significantly affects the choice of provider from whom care is sought and, for individuals who seek care from both provider types, that physician and non-physician services are substitutes. Our elasticity estimates provide a welfare economic argument supporting coverage parity of physician and non-physician mental health services.

Adult↗
PubMed1980

A multivariate analysis of long-term stay in private practice psychotherapy.

Investigated the characteristics predictive of long-term stay in private practice psychotherapy in a population of 64 "long-term" clients (remained longer than 25 sessions, mean = 47 sessions) and 88 "short-term" clients (terminated before 25 sessions, mean = 7 sessions). Data consisted of T-scores on the intake MMPI and two variables (possession of insurance coverage and use of psychoactive medication) on which long and short-term clients had been found to differ in other research. Stepwise multiple regression analysis was performed and revealed that MMPI scales 2 and 0 added to the prediction of length of stay in psychotherapy (p < .01). Insurance and medication were significant predictors only when MMPI data were not used.

Humans↗
PubMed1983

The effects of patients' fee payment source on the duration of outpatient psychotherapy.

Investigated the effects of fee payment source alone, as well as in combination with selected demographic factors (race, sex, education, and socioeconomic status), on the duration of outpatient psychotherapy. One hundred and sixty outpatients receiving treatment at a medical center based community mental health center served as Ss. These Ss were divided into four groups: Medicaid, insurance, insurance plus self-payment, and scaled self-payment only. Univariate results indicated that patients who paid a scaled fee had significantly more sessions than those whose fee was paid by Medicaid. Multivariate results, however, indicated that education and sex, which were highly correlated with fee payment source, accounted for most of the variance in treatment duration.

Ambulatory Care↗
PubMed1987

Third-party fee for service in children's mental health: limitation and suggestions.

The current third-party fee-for-service mode of reimbursement for mental health services emphasizes individual, pathology-oriented intervention and thus has disadvantages for clients and carriers. This article focuses on the mode's effects on outpatient services for children, youth, and families. It examines the ways in which common payment modes seriously limit services and create an incentive for psychologists to take a narrow, often nonempirical, perspective. Suggestions that allow for multisystem, ecological skill building hinge on building relationships between psychologists and the carriers. Desired results take two forms: modification of contingencies between providers and carriers and modification of contingency between insured and carrier. Examples of each are presented.

Adolescent↗
PubMed2006

Are mental health insurance mandates effective? Evidence from suicides.

Many states in the US have passed laws mandating insurance companies to provide or offer some form of mental health benefits. These laws presumably lower the price of obtaining mental health services for many adults, and as a result, might improve health outcomes. This paper analyzes the effectiveness of mental health insurance mandates by examining the influence of mandates on adult suicides, which are strongly correlated with mental illness. Data on completed suicides in each state for the period 1981-2000 are analyzed. Ordinary least squares and two-stage least squares results show that mental health mandates are not effective in reducing suicide rates.

Adult↗
PubMed2004

Dimensions of publicness and performance in substance abuse treatment organizations.

Changes in funding, clientele, and treatment practices of public and privately owned substance abuse treatment programs, compelled in part by increased cost containment pressures, have prompted researchers' investigations of the implications of organizational form for treatment programs. These studies primarily probe associations between ownership status, patient characteristics, and services delivered and do not empirically link organizational form or structure to treatment outcomes. Data from the National Treatment Improvement Evaluation Study (NTIES) were used to study the relationship of ownership and other dimensions of publicness identified in the public management literature to patient outcomes, controlling for patient characteristics, treatment experiences, and other program characteristics. A few effects of organizational form and structure on substance abuse treatment outcomes are statistically significant (primarily improved social functioning), although the specific contributions of measures of ownership and publicness to explaining program-level variation are generally small.

Evaluation Studies as Topic↗
PubMed1989

Recent developments in antitrust: challenges to medical autonomy.

Once exemptions from antitrust scrutiny were removed, economic arguments have proved effective in dissolving the hegemony formerly held by psychiatrists over the provision of mental health services. A growing number of courts, legislatures, and insurance companies have been persuaded by psychologists that they can provide at least comparable services at lower costs than psychiatrists. The fact that psychotherapy is less obviously a "medical" procedure than surgery or other physical treatments has facilitated the establishment of the psychologists' position. After these gains, there are indications that other mental health providers will follow the paths established by psychologists. Cost-containment efforts in the mental health care industry, particularly through health maintenance organizations, have already led to increased utilization of nondoctoral providers for initial screening services, and psychiatrists have even filed countersuits alleging restraint of their trade through the exclusive use of lower-cost providers (State Medical Society of Wisconsin v. Schweiker et al., 1982). With the clear message from many courts and legislatures that profession will no longer serve to distinguish among mental health providers, it appears that the validity of psychiatrists' assertions that independent practice by nonmedical mental health professionals will result in lower quality of care for patients will be tested in the marketplace, with peer review and tort litigation serving as the barometer by which that quality will be measured. And, as other nonmedical professionals establish their credentials through licensure and recognition by consumers, we can expect that they will also seek recognition of their capacities to provide (and be reimbursed for) professional services through the courts. With this greater access to consumers of mental health care will also come, of course, greater public scrutiny and greater risk of malpractice liability.

Allied Health Personnel↗