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PubMed1986

Use of outpatient mental health services by a general population with health insurance coverage.

Characteristics of use of mental health services by 4,254 persons enrolled in the Rand Health Insurance Study were analyzed in an attempt to predict patterns of use by a general population with assigned insurance coverage. Families in the study, whose members ranged in age from birth through 62 years, were randomly assigned to one of 14 insurance plans covering a wide variety of services by all licensed provider groups. During a one-year period less than 4 percent of the enrollees visited a mental health specialist, and only 7.1 percent saw any provider for mental health care. About half of those receiving outpatient mental health care visited general medical providers only. Annual outpatient mental health expenses per enrollee were about $25 (1983 dollars). The authors compare their findings with those of other studies and discuss their implications for insurance coverage of mental health services.

Ambulatory Care↗
PubMed1986

A proposal for future funding of chronic and episodic mental illness.

The estimated 1.7 to 2.4 million Americans who suffer from chronic mental illness are poorly served by the current nonsystem of services. No agency at any level is responsible for coordination of funding, treatment, and care. Since the mid-1950s funding has become increasingly fragmented as state mental hospitals have been depopulated, community services have been developed, and federal entitlement programs such as Medicaid, Medicare, and Social Security Disability Insurance have been introduced. To overcome the problems of fragmented funding and uncoordinated services, the authors propose establishment of a new federal entitlement program for the chronic mentally ill that would pool all existing funds regardless of the source. States would be empowered to develop a single administrative agency with responsibility for coordinating a comprehensive program of services.

Chronic Disease↗
PubMed1987

Changes in health care costs and utilization associated with mental health treatment.

Health insurance claims of families covered by Aetna's Federal Employees Health Benefit Program from 1980 through 1983 were analyzed to determine if any changes in total health care utilization and costs were associated with the initiation of mental health treatment. A total of 26,915 families in which at least one member received mental health treatment were compared with a randomly selected group of 16,468 families in which no member had received mental health treatment. Total health care costs for those receiving mental health treatment were significantly higher than costs for the comparison group. However, those costs dropped significantly after initiation of mental health treatment and continued to decline over the study period. The biggest declines occurred among persons age 45 and older, a finding that may have important policy considerations.

Community Mental Health Services↗
PubMed1989

Capitation plans.

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Capitation Fee↗
PubMed1989

Comparative costs and impacts of Canadian and American payment systems for mental health services.

In attempts to contain mental health costs, administrators are increasingly using incentives, competition, and accounting strategies and are creating more complicated financing systems. Yet the costs of these strategies and their impacts on the efficacy and efficiency of mental health services have yet to be studied. The authors compare mental health payment systems in British Columbia and Oregon. In the Canadian system, the patient is isolated from payment, sources of revenue are consolidated at the provincial level, only one payment mechanism per service type is used, health care documentation is oriented more to clinical needs than to reimbursement, and more discretion is delegated to providers. As a result, Canadian overhead costs are substantially less than those in the U.S. Patients have universal access to medical services in the Canadian system, and providers in hospitals, agencies, and individual practices have high incomes with low overhead costs.

British Columbia↗
PubMed1991

Managed care.

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Cost Control↗
PubMed1993

On being very smart: the mental health community's response in the health care reform debate.

President Clinton's proposal for a health care system based on managed competition began a dialogue within the mental health community about whether such a system would work in the mental health area. In early March a large coalition representing more than 30 mental health organizations, including advocacy organizations, state systems, professional associations, provider agencies, families, and consumers, formally transmitted to the President's Task Force on National Health Care Reform a document presenting a unified position on how mental health care should be delivered within a reformed health care system. The consensus document, reproduced here, maintains that a full range of services must be available to all children and adults with mental or emotional disorders. The document presents guidelines for containing costs, for standards of delivery for mental health services, and for the role of the states and the federal government within the new health care system.

Community Mental Health Services↗