Dickey B
McLean Hospital, Belmont, MA 02178, USA.
Health Policy. 1997 Sep;41 Suppl:S163-74. doi: 10.1016/s0168-8510(97)00043-2.
Mental health cost containment in the United States has evolved from fragmented utilization review and discounted pricing programs in the 1980s to comprehensive mental health managed care programs in the 1990s, in which the network managing the care takes on financial risks associated with price and utilization for all mental health services provided to an enrolled population. While the earlier programs did not control costs to any significant degree, the newer forms of managed mental health are showing substantial reductions in cost, primarily through the reduction in use of in-patient services. Based on these encouraging but very preliminary results, state Medicaid programs have increasingly embraced managed care for both medical and mental health services for eligible low-income populations. However, little has been systematically evaluated with respect to the effects of aggressive mental health care management upon quality of care, functional outcomes or patient satisfaction. In addition, substantial new investment in merged clinical and financial information systems raises the entry cost significantly for managed care providers.
美国心理健康成本控制已从20世纪80年代零散的利用审查和折扣定价计划，发展到90年代全面的心理健康管理式医疗计划。在该计划中，管理护理的网络承担与向参保人群提供的所有心理健康服务的价格和利用相关的财务风险。虽然早期计划在很大程度上没有控制成本，但新型的管理式心理健康正在显示出成本的大幅降低，主要是通过减少住院服务的使用。基于这些令人鼓舞但非常初步的结果，州医疗补助计划越来越多地为符合条件的低收入人群的医疗和心理健康服务采用管理式医疗。然而，关于积极的心理健康护理管理对护理质量、功能结果或患者满意度的影响，几乎没有进行系统评估。此外，对合并的临床和财务信息系统的大量新投资显著提高了管理式医疗提供者的进入成本。
