Stoil M J, Hill G A
Conwal Inc., McLean, VA, USA.
Behav Healthc Tomorrow. 1998 Aug;7(4):19-23.
Health maintenance organizations are supposed to maintain health, not just contain the cost of treating illness. Prevention and health promotion are critical mandates for managed care organizations, including managed behavioral health plans. More often than not, however, health plans have neglected to include prevention and behavioral health promotion services within their spectrum of covered benefits. In this article, the authors explain why there is a growing trend toward including coverage for prevention and promotion services in managed behavioral health plans, including the financial advantages and cost-containment opportunities that result. The article also illustrates several simple and straightforward models for structuring prevention benefits, managing the utilization and quality of prevention services, and including community-based preventive services organizations in provider networks.
健康维护组织的职责是维护健康，而不仅仅是控制疾病治疗成本。预防和健康促进是管理式医疗组织（包括管理式行为健康计划）的关键任务。然而，健康计划往往忽视在其涵盖的福利范围内纳入预防和行为健康促进服务。在本文中，作者解释了为何在管理式行为健康计划中纳入预防和促进服务覆盖范围的趋势日益增长，包括由此带来的财务优势和成本控制机会。本文还阐述了几种简单直接的模式，用于构建预防福利、管理预防服务的使用和质量，以及将基于社区的预防服务组织纳入提供者网络。
