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 343 records · Page 19Linked to original sources
PubMed2006

Financing mental health services for adolescents: a background paper.

Good mental health provides an essential foundation for normal growth and development through adolescence and into adulthood. Many adolescents, however, experience mental health problems that significantly impede the attainment of their full potential. The majority of these adolescents do not receive needed mental health services, in part because of financial obstacles to care. This article reviews the magnitude and impact of mental health problems during adolescence and highlights the importance of insurance coverage in assuring access to mental health services for adolescents. Significant limitations in private health insurance coverage of mental health services are outlined. Recent federal and state efforts to move toward parity in private insurance coverage between mental and physical health services are discussed, including an explanation of the role of Medicaid and the State Children's Health Insurance Program (SCHIP) in providing access to mental health services for adolescents. Finally, other elements that would facilitate financial access to essential mental health services for adolescents are presented.

Adolescent↗
PubMedDate not supplied

Psychiatry billing for nursing home services: understanding coding options.

This article reviews information on coding options, documentation, and payment for both initial and follow-up visits in the nursing home setting. Specific information is provided for both the psychiatry as well as the Evaluation & Management (E&M) code series. Payments are compared for comparable services in order to provide the nursing home psychiatrist with an understanding of the options available. Documentation, background information, and proposed note formatting are also provided. Proper use of the E&M series can provide valuable coding options.

Aged↗
PubMed2005

Private insurance and the utilization of chemical dependency treatment.

This study examines how different types of health coverage influence the likelihood of entering treatment for an alcohol problem, and the extent that people in treatment are able to use their insurance to help cover the costs of care. Survey data are analyzed from a sample of problem drinkers drawn from the general population and chemical dependency treatment programs in the same community. We find that, in comparison to being on Medicaid and being uninsured, having private coverage does not significantly alter the odds of treatment entry. Being in a private managed care plan, as compared to traditional indemnity coverage, also does not appear to impact the chances of treatment entry. However, having private coverage, as compared to being on Medicare, doubles the odds of treatment entry. For problem drinkers who obtain treatment, those with private coverage are as or more likely than other insured groups to report that insurance helped to pay treatment expenses. Even so, 10% of those privately insured report having paid for all of their treatment costs out of pocket. We conclude that, while prior studies have rarely found that having insurance significantly impacts alcohol treatment entry, the type of coverage one possesses may matter in some cases. Our results concerning Medicare coverage may point to potential problems with making treatment affordable to some problem drinkers outside the private insurance system.

Adult↗
PubMed2006

Case and care complexity in the medically ill.

The authors have argued that complexity in general health care is increasingly prevalent because of the increase in patients who have multimorbid conditions, and the increased professional and technical possibilities of medicine. In the increasingly complex care systems, it is necessary-specifically when treating patients in need of integrated care by several providers-that an optimal match between case and care complexity be found in order to prevent poor outcomes in this vulnerable group. The authors discussed several approaches to case complexity that can be identified in the literature. Most of them seem unsuitable for adjusting case and care complexity, and inadequate for designing multidisciplinary care. Theoretic approaches to case complexity may be of interest, but did not result in clinically meaningful information. The INTERMED, which can be considered the first empirically based instrument to link case and care complexity, is an attempt to improve care delivery and outcomes for the complex medically ill.

Cardiovascular Diseases↗
PubMedDate not supplied

Do individuals with substance abuse diagnoses incur higher charges than individuals with other chronic conditions?

Concerns about high costs have led to limits on the services covered by most insurance plans for substance abuse treatment. But, the commonly used comparison group for cost analyses, all enrollees in a health-care plan, may not be appropriate because addiction is a chronic condition. Therefore, to determine whether substance abusers incur higher charges than patients with other serious chronic conditions, we used health insurance information for employees and dependents over 3 years (1989 to 1991) for two firms with a total of almost 40,000 employees to do alternate comparisons. We compared average annual charges for patients with the following diagnoses: substance abuse, substance abuse with mental illness, arthritis, asthma, and diabetes. Patients who undergo treatment for abusing alcohol, drugs, or both often (but not always) incur higher charges than people with other chronic conditions. Clear differences in average charges emerge between patients with and without mental health claims.

Adult↗
PubMed1999

Hospitalization for mental illness in adolescents: risk groups and impact on the health care system.

PURPOSE: To determine the extent and cost of hospitalizations for mental illness among adolescents and to identify differences in acute care hospital use by gender and between racial/ethnic groups. METHODS: Analysis of discharge data for adolescents, 10 to 19 years of age (n = 27,595), with a principal diagnosis of mental illness from acute care hospitals in California in 1994. Relative risks (RRs) were calculated by race/ethnicity and gender and stratified by race/ethnicity and payment source. RESULTS: Mental illness accounted for 14.8% of hospitalizations in this age group; the mean length of stay was 10.9 days. Total charges exceeded $300 million. Overall, adolescent boys had a slightly lower risk of hospitalization for mental illness than did adolescent girls (RR = 0.90, 95% confidence interval [CI] = 0.87, 0.92) but a higher risk for certain diagnoses. Overall, nonwhite adolescents had a lower risk of hospitalization for mental illness than did white adolescents: African-Americans (RR = 0.77, 95% CI = 0.74, 0.81), Latinos (RR = 0.32, 95% CI = 0.31, 0.33), and Asians/others (RR = 0.27, 95% CI = 0.26, 0.29). These differences remained significant after stratification by payment source. CONCLUSIONS: The risk of hospitalization for mental illness among adolescents varies by specific mental illness and by race/ethnicity. In light of the significant human and financial costs associated with hospitalization for mental illness, further research into the determinants of illness and the options for care is warranted.

Adolescent↗
PubMed2001

Use of consumer ratings for quality improvement in behavioral health insurance plans.

BACKGROUND: The Consumer Assessment of Behavioral Healthcare Services (CABHS) survey collects consumers' reports about their health care plans and treatment. The use of the CABHS to identify opportunities for improvement, with specific attention to how organizations have used the survey information for quality improvement, is described. METHODS: In 1998 and 1999, data were collected from five groups of adult patients in commercial health plans and five groups of adult patients in public assistance health plans with services received through four organizations (one of three managed behavioral health care organizations or a health system). Patients who received behavioral health care services during the previous year were mailed the CABHS survey. Non-respondents were contacted by telephone to complete the survey. RESULTS: Response rates ranged from 49% to 65% for commercial patient groups and from 36% to 51% for public assistance patients. Promptly getting treatment from clinicians and aspects of care most influenced by health plan policies and operations, such as access to treatment and plan administrative services, received the least positive responses, whereas questions about communication received the most positive responses. In addition, questions about access- and plan-related aspects of quality showed the most interplan variability. Three of the organizations in this study focused quality improvement efforts on access to treatment. DISCUSSION: Surveys such as the CABHS can identify aspects of the plan and treatment that are improvement priorities. Use of these data is likely to extend beyond the behavioral health plan to consumers, purchasers, regulators, and policymakers, particularly because the National Committee for Quality Assurance is encouraging behavioral health plans to use a similar survey for accreditation purposes.

Adolescent↗
PubMedDate not supplied

Barriers to postpartum depression prevention and treatment: a policy analysis.

Public policy erects two barriers to adequate prevention and treatment of postpartum depression (PPD) in the United States: 1) the lack of parity between insurance coverage for mental and physical illness decreases access to care and 2) the current model of postpartum care fails to incorporate screening and follow-up. Treatment for PPD falls into the insurance category of mental health. But many insurance companies either do not cover mental illness at all or provide coverage that is far below that for physical ailments. Because cost-benefit analyses have shown the benefits of parity laws, legislation to achieve parity between mental and physical health insurance is crucial in addressing this problem. Meanwhile, the U.S. model of post-partum care should follow the example of care provided in the United Kingdom where nurse-midwives visit new mothers at home to check on their physical and emotional status. In one program that produced positive psychological health outcomes, midwifery visits were tailored to individual needs and extended to 10-12 weeks postpartum. Encouraging developments in the United States include 1) an effective program that screens new mothers with signs of PPD and provides telephone follow-up and rapid treatment referral and 2) proposed legislation to fund organizations working to reduce the incidence of PPD.

Adult↗
PubMed2000

Refining the costs analyses of the Fort Bragg evaluation: the impact of cost offset and cost shifting.

A key aim of the evaluation of the Fort Bragg Demonstration was to determine whether delivering services through a continuum of care lowered expenditures on mental health services. The evaluation clearly showed that expenditures were actually higher in the Demonstration. Critics of the evaluation claimed that the evaluation's perspective on costs was too narrow-in particular, that the Demonstration produced cost shifting and cost offset that were not captured by the evaluation. New data allow us to include a broader array of costs: mental health services received outside the catchment areas, general medical services for the children themselves, and mental health services used by family members. Results showed that reductions in other costs do partially offset higher expenditures on mental health services for children at the Fort Bragg Demonstration. However, even when broader costs are included, total family expenditures are still substantially higher at the Demonstration.

Adolescent↗
PubMed2001

Does the sunset of mental health parity really matter?

The 1996 Mental Health Parity Act (MHPA), which became effective in January 1998, is scheduled to expire in September 2001. This article provides an overview of what the MHPA intended to do and what it actually has accomplished. We summarize state legislature actions through the end of 2000 and report on their effects on employer-sponsored mental health coverage using a national survey fielded in 1999-2000. We then discuss possible amendments to the MHPA and reforms beyond full parity that might be considered.

Health Benefit Plans, Employee↗
PubMed2001

Hospitalization and total medical costs for privately insured persons with schizophrenia.

This study used data from the 1991-1993 MarketScan files, a large database of private sector inpatient, outpatient, and prescription drug medical claims, to identify a sample of 665 patients with schizophrenia. Descriptive and multivariate analyses were conducted on the subsamples with hospitalizations (N = 185) and without hospitalizations (N = 480) in the 1-year period following the initial diagnosis for schizophrenia observed in the 1991-1993 time period. After controlling for patient demographic characteristics, medical co-morbidities, and other factors, the cost of hospitalization itself was found to be $15,805.

Cost of Illness↗
PubMed2002

Mental health parity: a review of research and a bibliography.

This article summarizes the content of a meeting held in July 2001 to (1) review what is known about the effect of parity based on research already done, (2) identify what is likely to be known from research in progress, and (3) identify the knowledge gaps that still exist. An annotated bibliography of studies and reports on parity from 1996 through 2001 is included.

Bibliographies as Topic↗
PubMed1997

A four-year comparison of physical health benefit expenditures of mental and physical health claimants.

The pattern of covered physical health benefit expenditures before and after initiation of mental health treatment for a cohort of individuals with mild to moderate mental health problems was examined in this study. The results indicated the mental health treatment group (MHTG) began to have higher total covered benefits expenditures about one year prior to starting mental health treatment. Statistically significant differences between the MHTG and comparison groups (groups with no mental health treatments during the study period and matched on age and gender) began at the quarter just before treatment and continued through the seventh quarter after treatment initiation. The higher pattern of total health benefit expenditures of the MHTG declined gradually for two years before it returned to pretreatment levels. The study suggests the need for a better understanding of the types of physical health benefits expenditures preceding and following mental health treatment. It further indicates that the integration of physical and mental health benefits case management may have potential for reducing overall health benefit costs.

Adult↗
PubMed2003

Financing results and value in behavioral health services.

Current changes require that behavioral health care leaders understand how public and private financing mechanisms interact and how, now more than ever, behavioral health care leadership must span multiple systems and financing streams. Understanding how financing mechanisms work, what they create, and what they cause is essential if we are to make the most of increasingly limited and increasingly complex resource streams in today's health care market. This article explores a different paradigm of what adds value to publicly funded behavioral health care systems, and provides the framework for the American College of Mental Health Administration's call to behavioral health care administrators to take a new approach to the considerations behind funding decisions and payment mechanisms.

Behavioral Medicine↗