Ridgely M S, Goldman H H, Willenbring M
University of Maryland School of Medicine, Baltimore 21201.
Schizophr Bull. 1990;16(1):123-32. doi: 10.1093/schbul/16.1.123.
Among the frustrations of managing the dual disorders of chronic mental illness and alcohol and drug abuse is the fact that knowing what to do (by way of special programming) is insufficient to address the problem. The system problems are at least as intractable as the chronic illnesses themselves. Organizing and financing care of patients with comorbities is complicated. At issue are the ways in which we administer mental health and alcohol and drug treatment as well as finance that care. Separate administrative divisions and funding pools, while appropriate for political expediency, visibility, and administrative efficiency, have compounded the problems inherent in serving persons with multiple disabilities. Arbitrary service divisions and categorical boundaries at the State level prevent local governments and programs from organizing joint projects or creatively managing patients across service boundaries. When patients cannot adapt to the way services are organized, we risk reinforcing their overutilization of inpatient and emergency services, which are ineffective mechanisms for delivering the care these patients need. This article reviews the barriers in organization and financing of care (categoric and third party financing, including the special problem of diagnosis-related groups limitations) and proposes strategies to enhance the delivery of appropriate treatment.
在管理慢性精神疾病与酒精和药物滥用双重障碍时，令人沮丧的一点是，仅仅知道该做什么（通过特殊规划）不足以解决问题。系统问题至少与慢性病本身一样棘手。为患有合并症的患者组织护理并提供资金非常复杂。问题在于我们管理心理健康、酒精和药物治疗以及为这种护理提供资金的方式。单独的行政部门和资金池，虽然在政治权宜之计、可见性和行政效率方面是合适的，但却使为多重残疾者提供服务所固有的问题更加复杂。州一级任意的服务划分和类别界限阻碍了地方政府和项目组织联合项目或创造性地跨服务界限管理患者。当患者无法适应服务的组织方式时，我们就有可能加剧他们对住院和急诊服务的过度使用，而这些服务对于提供这些患者所需的护理来说是无效的机制。本文回顾了护理组织和资金方面的障碍（类别和第三方融资，包括诊断相关组限制这一特殊问题），并提出了加强提供适当治疗的策略。
