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PubMedDate not supplied

Financial management challenges for general hospital psychiatry 2001.

Psychiatry programs are facing significant business and financial challenges. This paper provides an overview of these management challenges in five areas: departmental, hospital, payment system, general finance, and policy. Psychiatric leaders will require skills in a variety of business management areas to ensure their program success. Many programs will need to develop new compensation models with more of an emphasis on revenue collection and overhead management. Programs which cannot master these areas are likely to go out of business. For academic programs, incentive systems must address not only clinical productivity, but academic and teaching output as well. General hospital programs will need to develop increased sophistication in differential cost accounting in order to be able to advocate for their patients and program in the current management climate. Clinical leaders will need the skills (ranging from actuarial to negotiations) to be at the table with contract development, since those decisions are inseparable from clinical care issues. Strategic planning needs to consider the value of improving integration with primary care, along with the ability to understand the advantages and disadvantages of risk-sharing models. Psychiatry leaders need to define and develop useful reports shared with clinical division leadership to track progress and identify problems and opportunities. Leaders should be responsible for a strategy for developing appropriate information system architecture and infrastructure. Finally, it is hoped that some leaders will emerge who can further our needs to address inequities in mental health fee schedules and parity issues which affect our program viability.

Budgets↗
PubMed1992

[Psychiatric evaluation in civil law].

Aspects of civil law of importance for the psychiatrist as expert witness are those dealing with disability pensions accident insurance, compensation in civil law and rights of the seriously disabled. The legal basis of each is briefly outlined, and some guidelines given for psychiatric court reports. Some outstanding theoretical and practical problems are mentioned.

Disability Evaluation↗
PubMed1998

Factors associated with involuntary return to a psychiatric emergency service within 12 months.

OBJECTIVE: This study examined patient characteristics and other factors that contributed to the involuntary return of patients to a psychiatric emergency service within 12 months of an initial evaluation in the service. The findings were used to consider whether the pressure to limit duration of hospital stays under managed care contributed to the patients' return to the emergency service. METHODS: Structured observations of evaluations of 417 patients admitted to the psychiatric emergency service were completed at seven county general hospitals in California. Twelve months after the initial evaluation, mental health and criminal justice records were reviewed for evidence of the patients' return for emergency psychiatric evaluation at any of the seven hospitals. Factors associated with patients' return to the psychiatric emergency service were evaluated using multivariate modeling. RESULTS: Of the 417 patients initially evaluated, 121, or 29 percent, were involuntarily returned to the psychiatric emergency service within 12 months. The likelihood of involuntary return was increased by a psychotic diagnosis and indications of dangerousness at the initial evaluation. Having insurance also increased the likelihood of involuntary return. CONCLUSIONS: The patient's initial condition in the psychiatric emergency service was found to be the best predictor of involuntary return. Brief hospitalization--an average of six days--after the evaluation did not have a significant prophylactic effect, perhaps because the reduced length of inpatient stay in the managed care environment did not allow adequate resolution of the patient's clinical condition.

Adult↗
PubMed1995

Crisis intervention and affective disorders: a comparative cost-effectiveness study.

In recent years, psychiatric institutions have been increasingly urged to justify their clinical policies in order to ensure both effective treatment and efficient management. Assessment instruments for effectiveness and costs are essential to respond to these needs. The aim of this study was to determine the cost-effectiveness of treatments for major depressive disorders. We conducted a comparative pilot investigation of treatment costs in patients with a major depressive episode assigned to specialised out-patient crisis intervention, to specialised in-patient treatment and to standard mental hospital care. The study included 122 subjects. The inclusion criteron was a diagnosis of DSM-III-R major depressive episode. Costs were assessed by determining the average cost for each treatment and the modalities of payment systems. Treatment duration and costs were high, but specialised crisis intervention may considerably reduce the duration of hospitalisation and its associated costs. The average costs of treating major depression were about 4 times greater in the specialised hospital unit than in the standard hospital unit and the crisis intervention centre. The burden of payment was comparatively higher for the state and reduced for insurance companies when the treatment of major depressive disorders involved less in-patient care.

Adolescent↗
PubMed2002

Socioeconomic differences in children's and adolescents' hospital admissions in Germany: a report based on health insurance data on selected diagnostic categories.

STUDY OBJECTIVE: The extent of social inequalities in children's hospitalisation risks was examined in terms of socioeconomic status and parents' nationality. This was considered in terms of inpatient treatment attributable to a number of diagnoses (ICD-9), especially infectious diseases and psychiatric disorders. DESIGN AND SETTING: Analyses were performed with records of a German statutory health insurance comprising 48 412 (52.8% male and 47.2% female) children and adolescents of 15 years of age or younger who were co-insured between 1987 and 1996. Classification of socioeconomic position was based on parental occupational position. RESULTS: Social inequalities in terms of hospital admissions attributable to acute diseases were rather small. The only exception were infections of the respiratory organs: in the highest status positions as compared with the lowest one the relative risk for being admitted was RR=0.22 (95% CI 0.06 to 0.89). However, length of stay in hospital was significantly related to socioeconomic position for infections of the upper respiratory tract and infections of the respiratory organs, with children and adolescents with the lowest socioeconomic background having spent the longest periods in hospital. With regard to nationality, pneumonia/flu was the only diagnostic category where relative risks for being admitted were higher in non-German children and adolescents (RR=1.5; 95% CI 1.2 to 1.8). Conversely, hospital admissions attributable to psychiatric diagnoses were significantly lower among non-German patients (RR=0.43; 95% CI 0.30 to 0.61), thus suggesting differential utilisation patterns according to nationality. CONCLUSIONS: Health inequalities in children's and adolescents' hospital admissions in Germany are small and inconsistent if parents' socioeconomic status and nationality are taken as criterion. Yet, children of lower status background stay longer in hospital if suffering from highly prevalent infectious diseases. This last observation may be attributable to more severe disease conditions.

Adolescent↗
PubMed2001

Demographics and health-related factors of men receiving prostate-specific antigen screening in Utah.

BACKGROUND: Identifying who is pursuing prostate-specific antigen (PSA) screening for prostate cancer is prerequisite to effectively influencing participation in PSA screening and educating people about potential screening implications and personal risk. This paper describes the relationship between select demographic and health-related factors with PSA screening. METHODS: Analysis was based on 1,293 men age 40 years or older who responded to a cross-sectional random telephone survey involving 12 health districts in the state of Utah from June 1 to August 31, 1996. Independent variables were current age, race, marital status, education, household income, medical insurance, level of physical activity, intake of fruits and vegetables, receipt of psychiatric help, religious preference, church attendance, general health status, and employment. RESULTS: Forty-eight percent of respondents reported having had a PSA in the past year. PSA screening in the previous year significantly increased and leveled off with age: 23.9% for ages 40-49, 51.4% for ages 50-59, 67.4% for ages 60-69, and 67.0% for ages 70+. After adjusting for age, only marital status and medical insurance were significantly related to PSA screening, with medical insurance having the largest effect. Approximately 50.6% married men and 33.5% unmarried men had a PSA in the past year. Percentages for insured and uninsured men were 49.4 and 16.6%, respectively. CONCLUSION: A substantial portion of elderly men, particularly those who are married and medically insured, have had a PSA test in the past year. This information makes it possible to more effectively influence participation in PSA screening and educate people about potential screening implications and personal risk.

Adult↗
PubMed2001

Relationship between compensation claims for psychiatric injury and severity of physical injuries from motor vehicle accidents.

OBJECTIVE: To examine the relationship between compensation claims for psychiatric injury after motor vehicle accidents and physical injuries sustained. DESIGN: Audit of Compulsory Third Party (CTP) insurance claims. SUBJECTS AND SETTING: 559 consecutive CTP claims referred by NRMA Insurance Limited to its sole provider of CTP legal services during a three-month period in 1994 after the claimant had engaged legal representation. MAIN OUTCOME MEASURES: Claim for psychiatric injury (any psychiatric disorder excluding traumatic brain injury) supported by a medicolegal report from a psychiatrist, other medical practitioner or psychologist; pre-existing psychiatric disorders; Injury Severity Score; initial treatment setting; hospital stay; percentage of accidents involving loss of consciousness or a death. RESULTS: 522 claims were eligible for the study; 19.5% (102/522) included a claim for psychiatric injury. A pre-existing depression or anxiety disorder was documented in 11 claims (2.1% of all claims and 3.9% of those claiming psychiatric injury). Only very severe injuries, particularly those involving loss of consciousness, were associated with an increased rate of claims for psychiatric injury. CONCLUSIONS: No association was found between claims for psychiatric injury and severity of physical injuries, except among those most severely injured.

Accidents, Traffic↗
PubMed1999

The biopsychosocial characteristics of people seeking treatment for obesity.

BACKGROUND: To determine prospectively the characteristics of obese patients allowed to select either a medically supervised weight-reduction treatment program or a surgical treatment program, both offered at the same location. METHODS: This was a cohort study at a university medical center where patients, who self-referred themselves for weight loss treatments, were introduced to two different programs before they were allowed to start either program. Four hundred forty-three patients with a mean body mass index (BMI) of 45.6 +/- 0.5 (85 men, 358 women) self-selected either a combined supplemented fast with behavior modification (DIET, n = 208) or gastric bypass surgery (SURG, n = 235). Three hundred forty of these patients had private insurance (PI,) and 103 were receiving Medicaid/Medicare (publicly funded, PF). Each patient completed a semistructured psychiatric interview, obesity questionnaire, Profile of Mood Status (POMS), Beck Depression Inventory (BDI), Minnesota Multiphasic Personality Inventory (MMPI), and Hollingshead Index. RESULTS: Three distinct groups of patients emerged on the basis of their insurance reimbursement patterns (employed versus disabled or indigent) and biopsychosocial factors. The disabled and/or indigent group receiving PF usually chose SURG (n = 89) because their insurance program covered it, but 14 disabled patients receiving Medicare chose DIET (together labeled the PF:DS group). The PI patients were divided into two groups: SURG (PI:S), n = 146, and DIET (PI: D), n = 194, respectively, based on their program selection. These three groups differed significantly in their biopsychosocial patterns. The PF:DS subjects appeared to have the strongest degree of biologic influence, followed by the PI:S and PI:D subjects. The pattern of social influences was consistent with the pattern of biologic influences and the selection bias created in forming the PF and PI groups. The pattern of psychologic influences, however, did not appear to follow the pattern of biologic and social influences. PF:DS had the strongest psychologic loading, but PI:D had a stronger degree of psychopathologic impairment than PI:S. CONCLUSIONS: The significant differences in the biopsychosocial characteristics of these three groups of obese patients need to be considered by policy-makers when they design and review treatment studies and decide what treatment programs should be offered in medical insurance programs.

Adult↗