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PubMed2004

Treatment retention among children entering a new episode of mental health care.

OBJECTIVE: This study examined use of mental health services among children and adolescents with private insurance who were entering treatment. Variations in service use were examined by age, gender, diagnosis, recent psychiatric hospitalization, and type of insurance. Differences between children who received treatment from mental health professionals and those who were treated by primary care physicians were also examined. METHODS: Drawn from a large database, the sample comprised 11,659 new users of mental health services. Service use was defined as the total number of days children were retained in treatment and the total number of mental health contacts recorded. RESULTS: The overall mean number of visits within a six-month period was 3.9. The average duration of treatment was 75.36 days. Children who were treated by a mental health specialist were less likely to drop out of treatment and had a larger number of visits. Severity of illness, psychiatric hospitalization, and managed care insurance coverage were also associated with lower risk of dropout and greater intensity of care. CONCLUSIONS: Children's access to services does not guarantee sustained involvement in treatment. To more fully address the nature of service use among children, a closer look at specific barriers to continued involvement in services is needed.

Adolescent↗
PubMed1990

How the medicare prospective payment system affects psychiatric patients treated in short-term general hospitals.

This study's purpose was to monitor changes in hospital utilization and discharge patterns for a large national sample of Medicare psychiatric patients treated in short-term general hospitals from 1980 through 1987. We compare data on the Medicare sample with trends for psychiatric patients with Blue Cross or private health insurance who were treated in the same hospitals. Study results indicate that treatment patterns changed for the Medicare psychiatric patients. Average length of stay decreased, especially for patients treated in scatterbeds. The proportion of patients discharged to other hospitals increased, and the number of admissions dropped for those patients over age 75.

Aged↗
PubMedDate not supplied

Psychiatric hospitalization and managed care in conflict.

The managed-care concurrent review process often results in denied or limited coverage of psychiatric inpatient care due to reviewers' misconceptions about psychiatric hospitalization and in an effort to achieve savings. For employers, such decisions may cost more in the long run.

Adult↗
PubMed2001

Are the care levels of people with dementia correctly assessed for eligibility of the Japanese long-term care insurance?

BACKGROUND: A new long-term care insurance system was launched in Japan in April 2000. OBJECTIVES: We performed the first national survey on special units of psychiatric hospitals for dementia patients to examine whether their disabilities were well reflected in the eligibility assessment. METHODS: Of all 248 dementia special units of psychiatric hospitals in Japan, 180 units (72.6%) participated in the survey. Five patients were randomly selected in each unit, and we used data of 802 (89.1%) of 900 patients whose care levels were obtained by the primary computer assessment. These patients were assessed using the Mini-Mental State Examination (MMSE), dementia rating scale by Gottfries et al. (1982) (GBS), and Activities of Daily Living (ADL). The mean score (SD) of the MMSE was 9.3 (6.9). RESULTS: Multiple regression analysis revealed that the scores of motor function in GBS, ADL, MMSE, and the degree of bedridden explained 73% of the variation of care level. The higher care levels were inversely related to lower MMSE scores. In the group of people who were not bedridden, the MMSE score sharply decreased even though their physical functions were maintained. There were no significant differences in the MMSE scores among the care level 1 and 5 groups except between care level 1 and 3 after controlling for the motor function scores in GBS. CONCLUSIONS: Our results suggest that care level and cognitive impairment are generally correlated in the primary assessment, but some adjustment measure for cognitive impairment is needed in mildly or moderately physically disabled patients.

Aged↗
PubMed2004

Use of medical and behavioral health services by adolescents with bipolar disorder.

OBJECTIVE: This study compared use of medical and behavioral health care by adolescents with bipolar disorder and other adolescents and identified areas in need of more clinical attention. METHODS: Medical and behavioral health insurance claims from 1996 for 100,880 adolescents were examined and categorized. Differences between and among various categories of disease were explored by using multivariate analyses. RESULTS: Among the 10,970 adolescents who used at least one behavioral health service, adolescents with bipolar disorder (N=326) had significantly higher behavioral health costs than those with mood or non-mood disorders, a result driven by these adolescents' significantly higher hospital admission rates for behavioral health care. Adolescents with bipolar disorder also had significantly higher medical admission rates compared with adolescents who had other behavioral health diagnoses. More than half of the 14 medical admissions for adolescents with bipolar disorder were due to drug overdose. CONCLUSIONS: Reallocation of medical and behavioral health resources to improve ambulatory treatment of bipolar disorder among adolescents has the potential to decrease the use and costs of health care while improving the welfare of these adolescents and their families.

Adolescent↗
PubMed2002

Utilization of psychotropic drugs in Taiwan: an overview of outpatient sector in 2000.

BACKGROUND: Development of pharmacological treatment in mental disorders has risen drastically over the past decade in Taiwan. We performed a survey of the National Health Insurance claims for outpatient psychiatric services to study the utilization of psychotropic drugs. The analysis followed the drug classification and standardized measurements proposed by the World Health Organization. METHODS: The sampling datasets from the National Health Insurance Research Database served as data sources. They represented 0.2% of the entire claims for outpatient medical services in 2000. The measurement units used for psychotropic drugs were either prescription volumes (drug items) or the number of defined daily doses (DDDs). To estimate the proportion of the population treated daily with psychotropic drugs, numbers of DDDs per 1000 inhabitants per day were also calculated. Beside overall description, the data of psychotropic substance prescriptions were analyzed by stratifying patient's age, physician's specialty, accreditation status of hospital, and chemical subgroup of psychotropic drugs. RESULTS: Prescription of psychotropic drug items (n = 63,539) was 3.24% of the total drug items (n = 1,958,820) claimed. The psychotropic drugs were prescribed to 9.2% of the total patients and in 9% of the total visits. Major consumers of psychotropic drugs were between 35-74 years of age and there were more women than men. The psychiatrist was the largest group of physicians who had prescribed psychotropic drugs and contributed 18.5% of all drug items and 38.3% of total DDDs of psychotropic drugs. The number of DDDs per 1000 inhabitants per day for all kinds of psychotropic drugs was estimated to be 32.94 in Taiwan, where anxiolytics accounted 14.30, hypnotics and sedatives 10.64, antipsychotics 3.41, antidepressants 3.06 and mood stabilizers 1.43. Ordered by total DDDs, the top 10 most frequently used chemical substances were flunitrazepam, alprazolam, fludiazepam, oxazolam, lorazepam, diazepam, zolpidem, estazolam, zopiclone, and haloperidol. CONCLUSIONS: The usage level of psychotropic drugs in Taiwan was lower than in most industrialized countries, especially for antidepressants. The future goals are to focus on the longitudinal analysis of general trend for each psychotropic substance and to associate the pharmacoepidemiological data in parallel with the upcoming epidemiological study of mental disorders in Taiwan.

Adolescent↗
PubMed1978

Trends in American mental health.

Using the data collected by Hollingshead and Redlich in 1950 and their own recent data, the authors describe trends in the mental health field over a 25-year period. They found a marked increase in admissions and readmissions to inpatient facilities and a significant decrease in the average length of stay; a considerable increase in outpatient treatment services; a shift in major diagnostic categories from schizophrenia to alcoholism; an unequal allocation of services to young versus elderly patients; discharge of many chronic patients to nursing homes; the increased involvement of psychiatrists in administrative work and decreased time spent in direct patient care; and an increase in third-party insurance as a source of patient fees.

Allied Health Personnel↗
PubMed1995

Research in adolescent suicide: implications for training, service delivery, and public policy.

Four domains of research in adolescent suicide are reviewed: (1) the role of psychopathology, (2) family history of psychopathology, (3) mental health treatments, and (4) firearms in the home. Based on the extant literature, recommendations are made for changes in training, service delivery, and public policy. Among the recommendations for training professionals are: an emphasis on diagnostic proficiency, skill and attentiveness in the assessment of the entire family unit, and assessment of the availability of firearms in the home. With respect to changes in service delivery, we recommend treatment of the entire family system, and treatment of psychiatric and substance abuse problems in the same setting, and we show the need for a continuum of intensity of care from inpatient to outpatient. With respect to policy changes, we recommended parity of mental and physical health insurance coverage, screening for psychiatrically at-risk youngsters in schools and physicians' offices, providing funding to support a continuum of care between inpatient and outpatient, and gun control laws to restrict access to handguns. We believe that these changes can result in a substantial reduction in the adolescent suicide rate.

Adolescent↗
PubMed1987

Hospital ownership and psychiatric services. Implications of ownership and reimbursement changes on lengths of stay and availability of services.

Dramatic increases have occurred in the proportion of for-profit hospitals in the general hospital sector; even more pronounced increases have occurred within the psychiatric sector. Concomitant with this changing mix of ownerships, revised reimbursement plans are being proposed for psychiatry. Thus, providers of acute psychiatric inpatient care, although loosely aggregated, constitute a service system that is experiencing dynamic revision. This article examines the implications of these changes for health policy analysts and planners in the design of hospital payment mechanisms and in planning for resources to meet the needs of the public. The state of California is viewed as a system, and data from the state are examined to test traditional assumptions of economic behavior when less costly substitute services are available. The availability of services such as outpatient clinics, emergency psychiatric services, and partial hospitalization are found to vary according to hospital ownership. Differences in availability of these services influence the access to inpatient care experienced by various populations within the defined system. Although these services may permit earlier discharge from the hospital, the poor insurance coverage of ambulatory psychiatric care relative to inpatient hospitalization distorts this effect. The implications of these findings for public policy are discussed.

California↗
PubMed1977

What is quality care? A clinician's view.

The prospect of national health insurance means the establishment of government criteria for reimbursable psychiatric treatment. These cost-control standards are certain to be justified on the basis of quality maintenance as well. Such preestablished criteria would not only fail to insure quality, they would likely undermine it. Steps toward an urgently needed definition of "quality treatment" are considered.

Cost-Benefit Analysis↗
PubMed1983

Recruitment of institutional psychiatrists for the 50 states.

We studied institutional recruitment of non-federal psychiatrists in 1979 as measured by national advertisements. Vacant positions in state mental hospitals and CMHCs are over-represented in the adverts compared to the current institutional distribution of physicians practicing psychiatry. States' per capita recruitment rates vary widely, but do not decrease linearly or exponentially with increasing abundance of psychiatrists. The percentage increase sought in institutional psychiatrists ('recruitment intensity'), however, does decrease exponentially as institutional psychiatrists/100,000 population increase. Recruitment rates and recruitment intensity are not highly correlated with states' sociodemographic characteristics or with characteristics of their health care systems. Private sector recruitment, however, is significantly higher in states that have mandated psychiatric benefit packages in private insurance. Studies relating institutional recruitment or vacancy rates to measures of local demand for psychiatric services are needed, as well as comparisons of successful versus unsuccessful institutions. Institutional vacancies are undoubtedly affecting the quality of care, compliance with standards for reimbursement and ability to generate third-party revenues. Greater understanding of institutional recruitment is needed.

Community Mental Health Centers↗
PubMedDate not supplied

The 'quiet' crisis in mental health services.

The failure of insurers and managed care organizations to reimburse providers of mental health services for the costs of care has led to a crisis in access to these services. Using the situation in Massachusetts as a case example, this paper explores the impact of this defunding. Unable to sustain continued losses, hospitals are closing psychiatric units, and outpatient services are contracting or closing altogether. The situation has been compounded by the withdrawal of many practitioners from managed care networks and cuts in public-sector mental health services. Unless purchasers demand effective coverage of mental health treatment, mental health services will likely continue to wither away.

Adult↗