Fourth revolution in the treatment of mental disorders: Rehabilitative entrepreneurship.

DRGs are not enough.

“…Psychology has a special role to play in the development of a prospective payment system policy, because many areas of psychological theory and research can contribute to the understanding and implementation of the psychosocial rehabilitation model (Magaro, 1985). One of the most notable of these areas is learning psychology, which has developed the behavioral technology that the psychosocial rehabilitation model assumes.…”

“…A more relevant model for addressing this issue and one that better fits the research on hospital utilization is the psychosocial rehabilitation model (Anthony, 1980; Leff, 1983; Magaro, 1985). Under the psychosocial model, psychiatric hospitalization is postulated to be the result of a lack of fit between a person’s need for community supports and the ability of family, friends, and available social services to provide these supports.…”

“…Second, CSMOs would receive their funds in the form of a capitation for each registered client rather than in the form of a grant for the provision of core services. Higher capitations could be paid for more disabled clients (Magaro, 1985). Third, CSMOs would have a significant financial incentive to increase clients’ daily living skills and thereby to reduce the unnecessary or inappropriate utilization of hospitals and other more restrictive living settings.…”

Cost-benefit analysis of six alternative payment incentives for child therapists.

“…The methods used to motivate mental health professionals seem to usually consist of only punishment by withdrawal (e.g., reductions in positive statements about a therapist's commitment to institutional objectives) or punishment by application (e.g., derogatory statements about a therapist's commitment or work style or threats of separation of the therapist from the position). A variety of positive reinforcement methods have been suggested by mental health researchers (e.g., Magaro, 1985), but few have been tested for effectiveness in a clinical setting. Because many incentive systems require monetary or other resources and because cost concerns are what prompt consideration of therapist incentives, it also seems important to examine the costs and benefits of any therapist incentive system.…”

“…Pomerleau, Bobrove, and Harris (1972) described a mental hospital in which aides received cash incentives for improving specific behaviors of their patients. Magaro (1985) advocated paying therapists in community mental health centers (CMHCs) for demonstrable progress in outpatient therapy rather than for simply the provision of therapy (see also DeMuth & Yates, 1981).…”