Evolutions in utilization and quality management

Cultural competence and quality of care: Issues for mental health service delivery in managed care.

“…From a mental health perspective, quality can been conceptualized in many ways. At the level of individual treatment, Menninger (1977) proposes an interactionist definition of quality as the “goodness of fit” between the problem requiring therapeutic attention, the desired outcome or goal of treatment, and the effectiveness of the treatment approach, as perceived by the patient, as judged by service providers, and as verified by outcomes studies (Rodriguez, 1989). In contrast, Byalin (1992) borrows a definition of quality from the industrial literature, viewing quality as “conformance to requirements, not as goodness” (Crosby, 1984, p. 64).…”

“…This strategy may backfire, however, if demand is too tightly regulated. Individuals may not seek help until their problems are more serious and treatment is more expensive, leading to higher hidden costs (Rodriguez, 1989). On one hand, then, insurance coverage should be generous enough to discourage excessive delays in help-seeking behavior.…”

“…There may be particular cause for concern with ethnic minorities, as obtaining specialty care was reported to be a major problem for 18% of ethnic minority adults, compared with 8% of White adults according to the Commonwealth Fund (1995) National Comparative Survey on Minority Health . In fact, Rodriguez (1989) points out that “through the processes of benefit denial and beneficiary silence, gatekeeper systems pose real and potential threats to access and quality in mental health services” (p. 260). Nevertheless, we do not have any data on how gatekeeping arrangements currently affect access to mental health services for ethnic minority populations.…”

“…Cost Containment Structures: Managing Demand Rodriguez (1989) notes that benefit redesign and structuring utilize employee co-payment as a means of controlling help-seeking behavior and demand for services. This strategy may backfire, however, if demand is too tightly regulated.…”

Psychiatric services for elderly people: Evaluating system performance

“…(Zelman, 1987, p. 205) Of course, evaluations of this type are also the subject of politics. National Health Services performance indicators were a political expedient (Harrison, 1988), and indeed, increased political concerns with narrow definitions of efficiency can be at the expense of evaluations of quality (Jerrell, 1986;Rodriguez, 1989;Appleby et al, 1993).…”