Mission unfulfilled: potholes on the road to mental health parity.
(17/1841)
Managed care holds the promise of facilitating parity between general medical care and alcohol, drug, and mental health care by reducing expenditures, even while expanding benefits. Limitations in our knowledge of variations in needs and treatment standards for substance use and psychiatric illnesses make such disorders an easy target for management. Costs for behavioral health care services have been reduced at a faster pace than has been the case for general medical care costs. The most severely ill face the potential burdens of managed care as access and intensity of care become more uniform across patient populations. (+info)
Equity in managed care for mental disorders.
(18/1841)
Equity of mental health care relative to general medical care is a long-standing policy issue in the mental health field, which in recent years has been debated as an issue of parity in insurance benefits. The shift toward managed mental health care makes the parity debate less controversial, because feared cost increases are an unlikely consequence under managed care. We argue, however, that managed care also makes benefit parity less relevant to the goals of achieving fairness in the delivery of mental health services. A broader policy perspective is required to encompass concerns about fairness under managed care. (+info)
Advances in understanding and treating mental illness: implications for policy.
(19/1841)
Mental illnesses have a significant impact on public health and contribute to a substantial part of the disability of the general population. Recent research on understanding and treating such illnesses has produced data that can inform policymakers about how to improve the condition of persons who suffer from these illnesses. This paper discusses how this research can be used to inform policy decisions regarding the allocation of community treatment resources and what research is still needed. (+info)
The value of mental health care at the system level: the case of treating depression.
(20/1841)
The value of mental health services is regularly questioned in health policy debates. Although all health services are being asked to demonstrate their value, there are special concerns about this set of services because spending on mental health care has grown markedly over the past twenty years. We propose a method for using administrative data to develop a comprehensive assessment of value for mental health care, which we call systems cost-effectiveness (SCE). We apply the method to acute-phase treatment of depression in a large insured population. Our results show that SCE of treatment for depression has improved during the 1990s. (+info)
State mental health parity laws: cause or consequence of differences in use?
(21/1841)
A new wave of state and federal legislation affecting mental health insurance was passed during the 1990s. Although patient advocacy groups have hailed the passage of numerous parity laws, it is unclear whether this activity represents a major improvement in insurance benefits or significantly increases access to mental health care. We investigated this issue with data from two new national studies sponsored by the Robert Wood Johnson Foundation. We found that states with below-average utilization were more likely to enact state legislation, but utilization in those states continues to lag behind the rest of the nation. (+info)
Effect of declining mental health service use on employees of a large corporation.
(22/1841)
This study examines concurrent changes in use of mental and general health services and in annual sick days among 20,814 employees of a large corporation. From 1993 to 1995 mental health service use and costs declined by more than one-third, more than three times as much as the decline in non-mental health service use. However, employees who used mental health services showed a 37 percent increase in use of non-mental health services and significantly increased sick days, whereas other employees showed no such increases. Savings in mental health services were fully offset by increased use of other services and lost workdays. (+info)
A framework for assessing the effectiveness, efficiency, and equity of behavioral healthcare.
(23/1841)
OBJECTIVE: To evaluate the effectiveness, efficiency, and equity of behavioral healthcare and to guide an assessment of the current state of the art of behavioral health-oriented health services research. STUDY DESIGN: The framework is grounded in previous conceptual work by the authors in defining a prevention- and outcomes-oriented continuum of healthcare and in identifying and integrating the concepts and methods of health services research and policy analysis for assessing healthcare system performance. PATIENTS AND METHODS: The defining assumptions are that (1) the denominator for behavioral healthcare services must encompass a look at the population, not just the patients, who manifest behavioral health risks; and (2) the delivery system to address these needs must extend beyond acute, treatment-oriented services to include both primary prevention and aftercare services for chronic relapsing conditions. RESULTS: Current policy and practice in behavioral healthcare reveal the absence of a comprehensive, coordinated continuum of care; substantial variation in policy and financial incentives to encourage such development; and poorly defined or articulated outcome goals and objectives. The current state of the art of research in this area reflects considerable imprecision in conceptualizing and measuring the effectiveness, efficiency, and equity criteria. Further, these 3 criteria have not been examined together in evaluating system performance. CONCLUSIONS: The first era of behavioral healthcare focused on cost savings in managed care alternatives; the second is focusing on quality and outcomes; a third must consider the issues of equity and access to behavioral healthcare, especially for the most seriously ill and vulnerable, in an increasingly managed care-dominated public and private policy environment. (+info)
Implementing effectiveness research and improving care for schizophrenia in real-world settings.
(24/1841)
OBJECTIVE: To review recent advances in medication practices and standards of care in the treatment of schizophrenia and examine the disparity between the knowledge base and clinical practice. DATA SOURCES: Key literature on medication practices, novel pharmacotherapies, and the evolution of practice guidelines for schizophrenia were reviewed. DISCUSSION: Emerging data demonstrate a lack of consistent application of current knowledge and best practices, in part due to major structural inconsistencies in the public mental health system. Implementation of results from effectiveness research as well as the incorporation of practice guidelines may help bridge this gap. CONCLUSION: As standards of care for schizophrenia are developed, the following issues will need particular attention: coordination with the criminal justice system, comprehensive treatment of comorbid illnesses, outcomes based on symptoms in all domains, and continuous and integrated collection of data to produce rational cost justification. (+info)