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PubMed1995

The role of private insurance in financing treatment for depression.

The health care system in the United States is expensive but fails large groups of its citizens, particularly those with serious mental illness. This paper examines the resource implications of adequate treatment for depression. An analysis of the various tasks necessary for a proper treatment program is used to indicate places where the current mechanisms of provision fall short. Appropriate innovations in principles of funding are suggested.

Costs and Cost Analysis↗
PubMed2005

Mental health care in Berlin.

AIM: To provide information on the mental health care system in Berlin, Germany. METHOD: Using available data we report on the spectrum of mental health care services provided in Berlin, the number of professionals working in these sectors, funding arrangements, pathways into care, and user/carer involvement. RESULTS: The health care system in Berlin consists of a network of inpatient, outpatient, ancillary, and rehabilitative facilities, all of which are meant to work in a synergistic fashion. However, although the individual treatment options are generally well-planned, there is still a lack of co-ordination between them. Currently, the entire network is threatened by cuts in state funding for ancillary and rehabilitative services, by further reductions in the number of hospital beds, and by insurance company cuts in prescription drug budgets, such as those used for atypical antipsychotics in outpatient care. DISCUSSION: Despite many similarities with the situation in other European capitals, the system of mental health care in Berlin suffers from a variety of problems related to co-ordination and costs that are unique to the German capital.

Berlin↗
PubMed1997

Issues in the psychiatric care of Hispanics.

Factors affecting the mental health care of ethnic minority groups in the United States deserve serious consideration. Hispanics, the second largest of these groups, face problems of access to care, high rates of substance abuse and HIV, and shortages of Hispanic psychiatric professionals. Recommendations for improving psychiatric care for Hispanics include changes in the areas of health insurance, research funding, affirmative action, and psychiatric training.

Cultural Characteristics↗
PubMed1995

The failure of the diversion process: the impact of transferring of patients to state hospitals.

The diversion of people with severe mental illness into the private sector is examined. The purpose of the diversion system is to reduce the number of admissions to the state hospitals by diverting patients into the private hospitals, which may offer more diverse treatment to these patients. Insurance is highlighted as an important factor in diverting patients from state hospitals. When the diversion system fails and the patient is transferred from the private sector to the state hospitals, continuity of care is disrupted. The failure of the diversion is more costly not only to the patient but to the federal and state governments as well. Policy issues such as cost to the mental health system and continuity of care are discussed.

Continuity of Patient Care↗
PubMedDate not supplied

Dramatic changes in care: the experience of one psychiatric hospital.

Recent and dramatic changes in this country's mental healthcare service are widely documented. To assess the extent and timing of those changes at one private psychiatric hospital, the authors examined length of stay, number of admissions, and patient age for general trends between 1980 and 1990 and more closely examined trends between July 1990 and December 1991. We related our findings to data for other private psychiatric hospitals and compared them with data from psychiatric units in general hospitals. The results are discussed in terms of changes in insurance coverage, changing utilization by different age groups, and a national shift from inpatient to outpatient care.

Adult↗
PubMed2006

The costs and benefits of enhanced depression care to employers.

CONTEXT: Although outreach and enhanced treatment interventions improve depression outcomes, uptake has been poor in part because purchasers lack information on their return on investment. OBJECTIVE: To estimate the costs and benefits of enhanced depression care for workers from the societal and employer-purchaser perspectives. DESIGN: Cost-effectiveness and cost-benefit analyses using state-transition Markov models. Simulated movements between health states were based on probabilities drawn from the clinical literature. PARTICIPANTS: Hypothetical cohort of 40-year-old workers. Intervention Enhanced depression care consisting of a depression screen and care management for those depressed vs usual care. MAIN OUTCOME MEASURES: Our base-case cost-effectiveness analysis was from the societal perspective; costs and quality-adjusted life-years were used to compute the incremental cost-effectiveness of the intervention relative to usual care. A secondary cost-benefit analysis from the employer's perspective tracked monetary costs and monetary benefits accruing to employers during a 5-year time horizon. RESULTS: From the societal perspective, screening and depression care management for workers result in an incremental cost-effectiveness ratio of $19 976 per quality-adjusted life-year relative to usual care. These results are consistent with recent primary care effectiveness trials and within the range for medical interventions usually covered by employer-sponsored insurance. From the employer's perspective, enhanced depression care yields a net cumulative benefit of $2895 after 5 years. In 1-way and probabilistic sensitivity analyses, these findings were robust to a variety of assumptions. CONCLUSION: If these results can be replicated in effectiveness trials directly assessing effects on work outcomes, they suggest that enhanced treatment quality programs for depression are cost-beneficial to purchasers.

Adult↗
PubMed1989

Survey of admission policies for child and adolescent inpatient services: a national sample.

In a national sampling of child inpatient directors, survey responses suggested variability in the use of many admission criteria. Yet, severity of symptoms, potential effectiveness of outpatient treatment, and extent of medical complications appeared to be commonly used admission criteria. DSM-III diagnoses were inconsistently used admission criteria, and many diagnoses were considered suitable for admission in extenuating circumstances only.

Child↗
PubMed2003

[German diagnosis-related groups. Problems in the field of mental and behavioural disorders shown in the example of hospital treatment of alcoholics].

Hospital treatment in Germany will clearly change: instead of paying by the number of days, blanket prices including all necessary benefits will become the norm. The nearly innumerable treatments possible were collected into diagnosis-related groups (DRGs) requiring similar clinicomedical benefits and consuming similar financial resources. The DRG classification in Germany (G-DRG) will be oriented to the Australian refined diagnosis-related group (AR-DRG) system, which has existed since 1998. German psychiatric hospitals have by policy not yet been involved in the new system. However, a big sector of psychiatric activity--as far as number of patients is concerned--has already been incorporated in this new system: detoxification from legal and illegal drugs is involved in G-DRG inasmuch as it does not take place in psychiatric hospitals. If the DRG system becomes established in German psychiatric hospitals, grave difficulties will occur. These problems are described together with the expected results in the example of hospital treatment of alcoholics.

Alcoholism↗
PubMed1991

Developing, assessing, and refining quality of care criteria for a CHAMPUS mental health services demonstration.

CHAMPUS established a contracted provider arrangement demonstration in the Norfolk, Virginia area. This article describes the development, assessment, and refinement of the quality monitoring criteria used to assess quality of care. Of 3,303 cases reviewed, 66% failed one or more criteria in two levels of review by nonphysician reviewers and were referred to peer reviewers. The referral problem was confirmed by the peer reviewer in at least 57% of the 2,177 cases. The criteria should undergo complete specificity and sensitivity testing, be expanded to include more outcome measures, and be applied to other geographic areas before use by other third party payors.

Clinical Protocols↗
PubMed2001

[Patients (getting themselves) referred to psychosomatic rehabilitation--guidelines for sociomedical evaluation and management of extrinsically motivated patients].

This paper reflects the thinking, experience as well as diagnostic and therapeutic strategies of the Gelderland specialized clinic for psychotherapy and psychosomatic medicine with regard to extrinsically motivated patients, i.e., patients "sent" for treatment. The objective is to develop a therapeutic concept and to establish guidelines concerning the sociomedical aspects to be taken into account in this patient group. The problem analysis should start out at the situation at hand initially: Not only do these patients as a rule refuse to take an active part in therapy; they all to often attempt to sabotage any rehabilitation offers perceived as running counter to their own desires and goals (e.g. pension, retraining, collection of benefits during illness-related unemployment, etc.). Attempts to elucidate the psychosomatic problem complex of these patients are in addition hampered by their predominantly body-centred concept of disease. The particular motivational and therapy-related features of these patients are illustrated by case studies. A standardized procedure for sociomedical performance appraisals is presented which takes the specific features of this patient group into account and has stood the test in the clinical setting. Special mention should be made of: pre-admission diagnostics, inpatient psychodiagnostics, multidisciplinary systematic behavioural observation of the patient in the framework of group therapy, and a sensitive approach to conveying diagnostic results to the patient. The double role of psychotherapist and appointed expert is one demanding the highest degree of professional expertise. Besides, the expectations of the social security and financially responsible agencies which "sent" the client have to be taken into account as well. The sociomedical evaluation serves as the starting point for all therapeutic efforts and identification of the extent of a patient's extrinsic motivation. Along with a thorough review of the patient's medical records, pre-admission diagnostic efforts are in place in this respect for assessing a patient's motivation for therapy.

Adult↗
PubMed1988

Psychiatric UR worksheet.

This worksheet was developed in response to an ever increasing number and intensity of admission and concurrent telephone reviews conducted by third and fourth-party payors. This worksheet was developed as an aid in information gathering for subsequent telephone and other reviews. The left-margin headings evolved from queries for information from the most demanding psychiatric nurse reviewers. When I have fully addressed all the information in my review, it is usually no problem in obtaining certification for admission or continued stay for the patient.

Alcoholism↗