Hogan M F
Ohio Department of Mental Health, Columbus 43266, USA.
Am J Manag Care. 1999 Jun 25;5 Spec No:SP71-7.
To describe the structure and status of public mental healthcare and the impact of managed behavioral healthcare on this system.
The structure and financing of public mental health systems were reviewed. Because there are no controlled multisite studies of managed public sector behavioral healthcare, case examples were used to illustrate trends and issues.
The methods, results, and impact of public managed behavioral healthcare are incomplete and uncertain. The complexity of the public sector system, the patients served in it, and the services provided are daunting. The variability of patient needs, the role of Medicaid versus state funding, and the variable governance structures of local systems in different states make managed care methods more complex than in private markets.
The organization, structure, and financing of public mental health systems have developed rapidly in the past generation as care has been moved from hospital to community. Early efforts to apply managed behavioral healthcare methods used in the private, commercially paid sector have not been very successful, and most public sector managed care efforts have been limited to Medicaid-paid care. The trend in public mental health systems is to "unpack" managed care and use its tools selectively.
描述公共精神卫生保健的结构与现状以及管理式行为健康保健对该系统的影响。
对公共精神卫生系统的结构与资金筹集情况进行了审查。由于缺乏对公共部门管理式行为健康保健的多地点对照研究，因此通过案例来说明趋势和问题。
公共管理式行为健康保健的方法、结果及影响并不完整且具有不确定性。公共部门系统、其中所服务的患者以及所提供的服务的复杂性令人望而生畏。患者需求的多样性、医疗补助与州资金的作用以及不同州地方系统的可变治理结构，使得管理式医疗方法比在私人市场中更为复杂。
在过去一代人的时间里，随着医疗服务从医院转向社区，公共精神卫生系统的组织、结构和资金筹集情况发展迅速。早期将私人商业付费部门所采用的管理式行为健康保健方法应用于公共部门的努力并不十分成功，并且大多数公共部门的管理式医疗努力仅限于医疗补助付费的保健。公共精神卫生系统的趋势是“分解”管理式医疗并选择性地使用其工具。
