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PubMed1990

[High frequency long-term analysis and psychoanalytic practice. Utopia and reality].

On the basis of the prognostic study of psychotherapeutic treatment in the Federal Republic and of the evaluation of more than 1000 applications for insurance benefits submitted in the years from 1973 to 1983, it is suggested that high-frequency long-term analysis is the exception rather than the rule and that it is carried on almost exclusively by a small group of "privileged" therapists. The author asks what this implies for the definition of psychoanalysis and for daily treatment practice. Are therapists being trained for a kind of treatment that they will rarely or never practice? The author urges resumption of the discussion of theory and technique of psychoanalysis in which these questions will be considered.

Cost Control↗
PubMed1990

The effects of a prepaid group practice on mental health outcomes.

Does a prepaid group practice relative to comparable fee-for-service plans lead to different mental health outcomes for its beneficiaries? To answer this question, we used data from the RAND Health Insurance Experiment. We observed no statistically significant or clinically meaningful differences in mental health outcomes for families randomly assigned to Group Health Cooperative of Puget Sound or to comparable fee-for-service insurance plans in the Seattle area. We found the same null result for overall mental health status as well as for psychological distress (e.g., anxiety and depression) and psychological well-being, and for the full population as well as the initially sick and poor, although our precision was low for the latter comparisons. Thus, the less intensive style of treatment in the prepaid group practice was not associated with noticeably worse mental health outcomes.

Adult↗
PubMed1990

Patterns of outpatient mental health care over time: some implications for estimates of demand and for benefit design.

The article examines patterns of starting and continuing outpatient mental health care as a function of time, and the implications of these patterns for estimates of the response of demand to generosity of fee-for-service insurance coverage. The data are from the RAND Health Insurance Experiment (HIE), which acquired a random sample of the nonelderly general population in six U.S. sites. People rarely had more than one episode of use of outpatient mental health services in a year. Persons who used in the prior year had high rates of continuing in treatment, while those without prior use entered treatment at a low, steady rate. Similar patterns of use by former users and nonusers were observed across insurance plans that varied widely in generosity, but the absolute probabilities of use were significantly lower in less generous plans. The probability of use of mental health services expanded significantly over time in the HIE; thus, estimates of demand in a steady state would be higher than those based on the HIE study years.

Community Mental Health Services↗
PubMed1990

Autonomy lost.

Explore the source record for details and available documents.

Adult↗
PubMed1989

[Is gambling a disease in the sense of section 169 of the federal insurance law?].

The socalled gambling addiction expresses itself as an exaggerated form of the gambling passion. The act of becoming fixed on or addicted to this (or another) behaviour pattern is always proceded by tentative situations man is succumbing to. The stimulant becomes increasingly more attractive. Regarding such a process, there is not criterion to determine a point when the addiction (which is not linked to a certain matter) becomes a disease. At all events, it is a legal matter to decide whether an extremely defective development that has obviously resulted into social ruin is to be regarded as a disease. The whole range of medical and educational requirements, however, has to be dealt with separately.

Gambling↗
PubMed1989

[The difficult neurotic patient from the psychiatrist's viewpoint].

Neurotic applicants for an infirmity-pension belong to the group of problem patients for attending general practitioners and specialists alike. The doctor-patient relationship is often disturbed. The source of the article emanates from problematic relationships. It is described how the psychiatrist deals with the difficulties in the expertise situation, where he attempts to gain insight into the personality structure. Furthermore, psychodynamics of a frequent personality structure of neurotic invalids are described. Finally, reference to literature is introduced and discussed.

Eligibility Determination↗
PubMed1989

Determining provider choice for the treatment of mental disorder: the role of health and mental health status.

This article specifies and estimates a model of provider choice for mental health services. Three types of providers are identified: specialty mental health providers, general medical providers, and informal providers. Specific attention is paid to the role of health and mental health status in determining provider choice. The model is estimated using a multinomial logit approach applied to a sample of 2,800 respondents to the Baltimore Epidemiological Catchment Area Survey. The results are largely consistent with the previous work of Wells et al. (1982), suggesting that health and mental health status play an important role in the decision to seek care but have little effect on the type of provider chosen. The results also reveal that 22 percent of individuals obtaining mental health care did so through the informal care sector. One exemplary benefit design simulation is performed using the estimation results.

Baltimore↗
PubMed1989

[Temporal markers of analytic psychotherapy in relation to health insurance management].

A sample (N = 1142) of applications for psychotherapy made at the health insurances was analyzed of characteristics as status of therapist, total number of sessions and weekly frequency of sessions. Analytic individual psychotherapy was the most often applicated (40%) of the four analyzed methods (depth-psychologically founded respectively analytical, individual respectively group psychotherapy). With regard to individual analytic psychotherapy low-frequent therapies (one or two sessions weekly) are as usual as higher-frequent ones (three or four sessions weekly). Only 20% of these higher-frequent therapies seemed to last more than 240 sessions totally.

Germany, West↗