Managed Care and Mental Health Services: Lessons for Health Care Providers

Abstract

Managed health care has grown rapidly during the past decade and is likely to continue its expansion during the next several years. Psychiatric services have been subject to especially stringent efforts to control costs, including intensive utilization review and formation of provider networks that primarily utilize master level professionals. Psychiatrists' responses to these changes have ranged from antagonistic to proactive. The most effective actions are proactive ones that attempt to shape these new health care systems. A thorough understanding of the impact of managed care upon psychiatry and of psychiatrists' responses can help providers in other medical specialties as they develop their own strategies to cope with the changing health care environment.

Economic Evaluations and Interventions for Children and Adolescents with Mental Health Problems

“…The main reason for the growth of what has become know as " managed care" in the U.S, was that the costs of mental health care falling to employers and other payers were increasing rapidly (Dorwart, 1990;Frank, Salkever & Sharfstein, 1991), including claims for mental health treatments for dependents (Tsai, Bernacki & Reedy, 1987), For example, mental health admissions of dependents aged under 18 increased more than four-fold just between 1980 and 1984 (Scherl, 1985), The incentives inherent in many reimbursement arrangements were pushing children into more restrictive settings than were needed (Behar, 1985;Frank & Dewa, 1992;Knitzer, 1982Knitzer, , 1993, and there have been pressures from thirdparty payers to reduce length of stay in expensive inpatient beds , Finding cost-effective alternatives to inpatient treatment can reduce overall expenditures without damaging outcomes. But "the determination of interventions and services that are costeffective depends solely on the availability and quality of services research and evaluation information, which is still hmited" (Bickman et al, 1996, p. 4), Managed care "includes (i) benefit limits, cost sharing and pricing approaches; (ii) organizational arrangements; and (iii) case management techniques" (Untitzer & Tischler, 1996, p.493).…”

Effects of a clinical feedback system on client and therapist outcomes in a rural community mental health center

“…From 1965 to 1992, health care costs rose from 7% to 13% of the gross national product. Much of this increase was due to the increased use of inpatient psychiatric and substance abuse services (Fuller, 1995;Schuster, 1993). Insurance coverage had traditionally favored inpatient hospitalization for mental health care, which undoubtedly influenced the use of this service over less expensive alternatives, such as partial hospitalization, day treatment, or outpatient care (Inglehart, 1996a).…”