The Impact of HMO Development on Mental Health and Chemical Dependency Services

Shadle, Maureen; Christianson, Jon B.

doi:10.1176/ps.40.11.1145

Cited by 10 publications

(5 citation statements)

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“…Before 1990 most of the focus on managed care had been on health maintenance organizations (HMOs) (324)(325)(326)(327)(328)(329)(330)(331). In 1990 Dorwart (332) discussed myths about managed mental health care, including that managed care caused, and that managed care would cure, the current problems of mental health care.…”

Section: Economicsmentioning

confidence: 99%

The Last Half-Century of Psychiatric Services as Reflected in Psychiatric Services

Geller¹

2000

132

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The last half-century of psychiatric services in the United States is examined through developments and trends reported in the 50 years of publication of Psychiatric Services. The journal, earlier named Mental Hospitals and then Hospital and Community Psychiatry, was launched by the American Psychiatric Association in January 1950 and marks its 50th anniversary this year. The author organizes his review of psychiatric services largely around the locus of care and treatment because the location of treatment--institution versus community--has been the battleground for the ideology of care and for the crystallization of policy and legal reform. He uses "dehospitalization" to describe the movement of patients out of state hospitals, rejecting the widely used term "deinstitutionalization" as inappropriate; one reason is that the term wrongly implies that many settings where patients ended up were not institutional. Also covered in detail, as reflected in the journal, are community care and treatment, economics, patient empowerment, and the interface issues of general hospitals, outpatient commitment, and psychosocial rehabilitation. The author notes that some concepts, such as outpatient commitment and patient empowerment, emerged earlier than now assumed, and that others, like psychosocial rehabilitation, recurred in slightly different forms over time. He concludes that even after 50 years of moving patients out of state hospitals and putting them somewhere else, mental health policymakers and practitioners remain too myopically focused on the locus of care and treatment instead of on the humaneness, effectiveness, and quality of care.

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Section: Economicsmentioning

confidence: 99%

The Last Half-Century of Psychiatric Services as Reflected in Psychiatric Services

Geller¹

2000

132

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“…More timely care may avert direct and indirect costs of psychiatric morbidity and mortality, and reduce expenses for general medical care (Jones and Vischi, 1987; Pincus, 1984; Pincus, 1990; Richman, 1990; Shuster, 1992). Savings have been reported from treatment in less intensive mental health settings, such as those found in health maintenance organizations, where MH costs have been found to be lower (Diehr et al, 1984; Norquist and Wells, 1991; Shadle and Christiansen, 1988; Shadle and Christiansen, 1989; Wells et al, 1986). In a pilot study of patients in two rural HMOs, we found that patients in the primary care site which had weaker mental health consultative linkages had more mental health hospital utilization as well as higher overall healthcare costs (Yuen et al, 1996).…”

Section: Dimensions Of Pcp/mh Linkagementioning

confidence: 99%

Linkages between primary care physicians and mental health specialists.

Yuen

Gerdes²,

Waldfogel³

1999

Families, Systems, & Health

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Primary care physicians (PCPs) are integral to the provision of mental health (MH) services. Linkages between PCPs and MHproviders are a vital component of care for psychiatric patients. This paper reports on an exploratory survey of PCPs about their relationships with mental health specialists. PCPs affiliated with Jefferson Medical College in Philadelphia, Pennsylvania were surveyed on the nature and quality of consultation and referral practices they had with individual mental health providers and mental health carve-out organizations. The survey was based on published literature regarding collaboration in healthrelated and non health-related organizational settings. Ninety-nine attending physicians responded to the survey. Physicians'ability to treat MH patients was positively related to the availability of MH consultation (p=.O29). 48.5% of PCPs reported never/ seldom providing information to MH carveouts, compared to 16.2% to individual MH providers (p-.OOl). Receipt of patient information back from MH providers was poor-54.4% reported never / seldom receiving information back from MHcarveouts, compared to 47.

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“…In HMOs, for example, mental health benefits typically cover twenty outpatient visits and thirty inpatient days per year; a $20 copayment per outpatient visit is common (American Association of Health Plans, 1996). Furthermore, the emphasis historically has been on an acute care benefit, with coverage often restricted to services appropriate for short-term treatment or crisis intervention (Shadle and Christianson, 1989). In 1990, 46 percent of HMOs excluded treatment for chronic mental illness (Christianson, Whole3 and Peterson, 1997), though plans probably varied in how tightly this was defined.…”

Section: Current Practices In Managed Carementioning

confidence: 99%