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PubMed1978

The psychiatrist and health insurance claims review.

Expanded health insurance benefits for the treatment of mental illness have obliged psychiatrists to devote more time to justifying psychiatric treatment to claims reviewers. The author, drawing from experience in utilization review and peer review, summarizes factors contributing to the denial of payment for psychiatric services by health insurers, and gives practical advice on protecting against claims denials and on the process of appealing denials. Psychiatrists should make greater use of peer review committees to justify legitimate treatment services in the face of claims denials. Greater coverage for psychiatric treatment under national health insurance will increase the psychiatrist's responsibility for public accountability. This accountability will require better communication between psychiatrists and claims reviewers.

Insurance Benefits↗
PubMed1981

Psychiatrists' distribution across the 50 states, 1978.

In 1978, both psychiatrists and a nonmedical professional group (lawyers) were more abundant in more populous, urbanized states. Lawyer-population ratios, however, correlated more strongly with the population's wealth; psychiatrist-population ratios correlated more strongly with the percentage of state population with college education and with state-mandated private insurance coverage of psychiatric services (both probable indexes of market demand). Even after controlling for population size and education, state-mandated insurance coverage was significantly related to the abundance of psychiatrist. Moreover, mandating states increased their psychiatrist-population ratios 100% faster after mandating coverage, whereas nonmandating states increased their ratios only 25% faster in comparable periods. While we investigate psychiatrists' geographic distribution, public policy formation can be aided if we also seek better measures of access and barriers to psychiatric care.

Education↗
PubMed2001

Trends in psychiatric inpatient rates from 1991-1995 in the State of Washington: the effect of insurance type on utilization.

This study examined whether there have been changes in inpatient psychiatric use among publicly and privately insured patients by analyzing trends in adult psychiatric hospitalizations from 1991 through 1995 in the State of Washington. A state-wide Comprehensive Hospital Abstract Reporting System (CHARS) was used to track psychiatric hospital utilization patterns. The results show a significant growth in psychiatric hospitalizations among the publicly insured patients due to their high proportion of severe and persistent mental illness. There was a flat trend in psychiatric hospitalizations suggesting that private insurers aggressively monitor the costly use of hospitalizations for mentally ill patients.

Adult↗
PubMed1995

Factors associated with inpatient and outpatient treatment for children and adolescents with serious mental illness.

OBJECTIVE: This study describes the distribution of children and adolescents in psychiatric inpatient and outpatient facilities and identifies factors associated with the selection of individuals into inpatient versus outpatient care. SAMPLE DATA: The data are from a 1986 nationally representative sample surveyed by the National Institute of Mental Health. RESULTS: Results indicate that the vast majority of children and adolescents with psychiatric problems receive outpatient treatment rather than inpatient care. Factors that predict psychiatric hospitalization rather than outpatient care are (1) public or private insurance coverage versus no insurance; (2) previous hospitalization; (3) psychiatric diagnosis of affective or psychotic disorders versus conduct disorders, adjustment disorders, drug and alcohol abuse, and other disorders; and (4) age, with adolescents more likely to be hospitalized than children. CONCLUSIONS: Further research is needed to explore the role of insurance in mental health sorting processes. Moreover, systematic, controlled research is needed to determine how different financing strategies affect mental health outcomes for children and adolescents.

Adolescent↗
PubMed2004

The quiet epidemic.

More than half of patients treated in hospitals may suffer from depression or some other mental disorder that affects their health care. Misdiagnoses, wrong treatments, payment issues and a stigma about mental disorders that persists among the public, insurers and patients even in this enlightened era affect health care in ways we might not even realize.

Attitude to Health↗
PubMed2002

Psychiatry of the medically ill in the burn unit.

Clinical experience and burn survivor testimony show that the experience of being burned can be associated with catastrophic stress and lead to drastic permanent body image changes from scarring and limb-function loss. Close relatives, if not killed in the fire, often also experience clinically significant bystander stress. Closeness of relationships may be lost, and self-image may suffer. Property damage and loss of crucial resources may be associated with fires. Although many burns result from accidents, most result from preventable causes associated with psychiatric disorders, which include mood disorders, psychoses, cognitive disorders, and substance-use disorders. Burns then result from: Deliberate self-harm Impaired judgment and poor coordination associated with substance intoxication Risk-taking behavior Poor supervision of children and impaired elderly persons Careless handling of flammable materials. Many clinical syndromes, such as delirium, ASD, acute psychosis, suicidality, and pain need to be addressed by the consulting psychiatrist to facilitate surgical treatment of the burn injury. Other psychiatric disorders, such as PTSD, major depression, and adjustment disorder, need to be treated to expedite long-term adjustment. Hospital length of stay and RTW/RTS are major outcome variables. The psychiatry consultant can positively affect both variables substantially using both pharmacologic and psychosocial measures. The important role of psychiatric issues both before and after burn injury support the need for more consistent and comprehensive medical insurance coverage for psychiatric consultation to burn units and clinics. Burn Support Groups are an invaluable asset.

Adaptation, Psychological↗
PubMed2003

Psychiatric inpatient, outpatient, and medication utilization and costs among privately insured youths, 1997-2000.

OBJECTIVE: The study examined trends in use of inpatient and outpatient mental health services, including pharmacotherapy, among privately insured children and adolescents from 1997 to 2000. METHOD: Data from a national database of more than 1.7 million privately insured individuals were used in an analysis of inpatient, outpatient, and pharmacy claims of users of mental health care age 17 years and younger (approximately 20,000 patients per year). Annual utilization rates and adjusted costs for services and dispensed psychotropic medications were calculated. Results from 1997 and 2000 were compared across diagnostic and age categories. RESULTS: The proportion of youths with an inpatient psychiatric admission decreased by 23.7% from 1997 to 2000, and annual inpatient and outpatient costs decreased by 1,216 US dollars (18.4%) and 157 US dollars (14.4%), respectively. Decreases were driven by a reduction in inpatient days (20.0%) and by a combination of a reduction in outpatient visits (11.3%) and declining payments per outpatient visit (6.1%). Payment trends across diagnoses varied considerably, with the largest reductions seen in treatment of depression, hyperactivity, adjustment disorders, and anxiety disorders. Over the same period, the proportion of youths receiving medication increased by 4.9%, and mean annual medication-related costs per outpatient increased by 41 US dollars (12.1%). CONCLUSIONS: Reductions in inpatient and outpatient mental health service intensity and reimbursements documented in previous research continued through the late 1990s. Declines were accompanied by concurrent increases in the use of and costs associated with psychotropic medications, particularly for youths with mood and anxiety disorders. These results document a shift toward medication-based outpatient treatment modalities.

Adolescent↗
PubMed1984

[Community short-term therapy of addicts as influenced by the identity of the insurer--the East Bremen example].

Following the agreement on the splitting of the burden of cost to be borne by the Federal German national health and pension insurance schemes, the cost of treatment of addicts has been divided between the relevant bodies. This division of cost has developed into an obstacle especially to the development of curative treatment in community areas close to patients' domiciles. The article analyses the example of the Addicts Department of the Bremen-Ost Central Hospital to demonstrate the partly absurd and illogical sequelae of various cost allocation regulations for the motivation and treatment of addicts.

Alcoholism↗
PubMed1977

State laws mandating mental health insurance coverage.

Insurance companies and administrators of group insurance plans have accepted the premise that coverage for mental illness must be different from coverage for other health problems, and thus insurers continue to limit their liability through various exclusions and restrictions. For several years providers and consumers of services have worked for the enactment of state laws that mandate or regulate certain kinds of coverage for mental illness; as of January 1, 1977, a total of 22 states had such statutes. The author presents a state-by-state summary of the provisions. He also classifies many of the provisions into six categories and discusses the probable basis for their enactment.

Ambulatory Care↗
PubMed1976

The impact of national health insurance on the tasks and practice of psychiatry.

Psychiatry, like all professions, is strongly affected by changes in societal expectations and economic forces. Changes in professional priorities and patterns of patient care will undoubtedly be brought about by national health insurance. Two major types of national health insurance have been proposed: comprehensive health insurance and catastrophic insurance. We do not anticipate major impact on psychiatric tasks from some form of catastrophic insurance. Comprehensive health insurance would shape and change psychiatric practice. An examination of psychiatric tasks provides a framework for anticipating alterations in practice. We identify four major task areas in psychiatry: (1) medical tasks, (2) reparative tasks, (3) social control tasks, and (4) humanistic tasks. These tasks would be differentially influenced. Psychiatry's medical tasks will be stressed, while funding for many reparative tasks may be limited. The care of the severely ill patient may be fragmented because of problems in integrating medical and rehabilitative services.

Humans↗