Geraty R, Bartlett J, Hill E, Lee F, Shusterman A, Waxman A
Medco Behavioral Care Services, USA.
Behav Healthc Tomorrow. 1994 Mar-Apr;3(2):18-30.
As Congress debates the Health Security Act, a key issue centers on whether and how to include mental health and substance abuse benefits and how to contain costs if and when these benefits are paid at parity with general healthcare. Previous studies estimating the average annual cost of providing behavioral healthcare services have shown considerable divergence, depending on the nature of the defined population and the inclusion of various benefit categories, out-of-pocket expense and administrative costs. Experience from 14 members of the American Managed Behavioral Healthcare Association (AMBHA) is used to define the key features of managed behavioral healthcare, and to demonstrate that a properly managed behavioral healthcare benefit can be significantly less costly than the current reform debate would admit. AMBHA companies (which have many years of experience and presently manage the cost and quality of care for over 65 million people in the United States) [See Table 3, page 28], have shown that a specialty managed care approach can achieve not only significant savings to healthcare providers, payers and society, but also improve quality and access to care. Traditional attempts at reducing mental illness benefit coverage costs have entailed limitations on the availability or access to care. These approaches, however, ignored the larger implications to society of untreated mental illness and chemical dependency. When traditional coverages have offered more extensive benefits, they have primarily favored inpatient treatment, thus increasing costs by overemphasizing care of patients at expensive inpatient settings. AMBHA's proposed principles of healthcare reform and recommended benefit packages for behavioral healthcare can be found on page 80 of this magazine.
在国会就《健康安全法案》展开辩论之际，一个关键问题集中在是否以及如何纳入心理健康和药物滥用福利，以及如果这些福利与一般医疗保健平价支付，如何控制成本。先前估计提供行为医疗保健服务的年均成本的研究显示出很大差异，这取决于定义人群的性质以及是否纳入各种福利类别、自付费用和行政成本。美国管理行为医疗保健协会（AMBHA）14个成员的经验被用于定义管理行为医疗保健的关键特征，并证明妥善管理的行为医疗保健福利的成本可能比当前改革辩论所承认的要低得多。AMBHA的公司（拥有多年经验，目前在美国为超过6500万人管理医疗成本和质量）[见第28页表3]表明，专业管理式医疗方法不仅可以为医疗保健提供者、付款人和社会节省大量资金，还可以提高医疗质量和可及性。传统上试图降低精神疾病福利覆盖成本的做法导致了获得医疗服务的限制。然而，这些方法忽略了未治疗的精神疾病和药物依赖对社会的更大影响。当传统保险提供更广泛的福利时，它们主要倾向于住院治疗，从而因过度强调在昂贵的住院环境中照顾患者而增加了成本。AMBHA提出的医疗改革原则和推荐的行为医疗保健福利套餐可在本杂志第80页找到。
