Jones Kristine, Chen Huey Jen, Jordan Neil, Boothroyd Roger A, Ramoni-Perazzi Josefa, Shern David L
Center for the Study of Issues in Public Mental Health, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York 10962, USA.
Med Care. 2006 Apr;44(4):320-7. doi: 10.1097/01.mlr.0000204302.26073.13.
We examined the effects of differing financial risk arrangements for mental health, physical health, and pharmacy services on the overall costs of these services with particular attention to cost containment and cost shifting.
Comprehensive service utilization information was obtained from a sample of 458 adults with severe mental illnesses during a 12-month period. Rate information was used to calculate costs for health, mental health and pharmacy. A 2-part model was employed to test for differences among financial risk conditions.
Total treatment costs, both those financed by Medicaid and those paid by other sources, were lower in plans that had a broader array of services for which they were at risk. Pharmacy costs were principally responsible for these differences.
Treatment costs for adults with severe mental illnesses can be contained by placing providers at financial risk. However, risk arrangements may also increase treatment costs borne by other payers including charity services and self-pay. Evaluating the impact of at-risk financing mechanisms from a public health perspective requires assessing cost shifting, particularly for pharmaceuticals.
我们研究了针对心理健康、身体健康和药学服务的不同财务风险安排对这些服务总体成本的影响，尤其关注成本控制和成本转移。
从458名患有严重精神疾病的成年人样本中获取了为期12个月的综合服务利用信息。费率信息用于计算健康、心理健康和药学方面的成本。采用两部分模型来检验财务风险状况之间的差异。
在承担风险的服务范围更广的计划中，由医疗补助计划资助的治疗总成本以及由其他来源支付的治疗总成本均较低。药学成本是造成这些差异的主要原因。
通过让提供者承担财务风险，可以控制患有严重精神疾病成年人的治疗成本。然而，风险安排也可能增加包括慈善服务和自付费用在内的其他支付方承担的治疗成本。从公共卫生角度评估风险融资机制的影响需要评估成本转移情况，尤其是药品方面的成本转移。
