Haber S, McCall N
Inquiry. 1989 Summer;26(2):158-69.
Rising Medicare costs and concern about inadequate access to physician services have prompted interest in extending independent practitioner status to nonphysician providers. This paper reviews the findings from a demonstration project that tested whether recognizing clinical social workers (CSWs) as independent practitioners in the Medicare program would be a cost-effective method to improve access to needed mental health services. The demonstration showed little impact on access and no clear evidence of savings, despite the lower cost of CSW services compared with those of psychiatrists. Differences between CSWs and psychiatrists in treatment patterns and treatment settings, however, suggested that for some patients CSWs might be an appropriate alternative source of care.
医疗保险成本的不断上升以及对医生服务获取不足的担忧，引发了人们对将独立从业者身份扩展至非医生提供者的兴趣。本文回顾了一个示范项目的研究结果，该项目测试了在医疗保险计划中认可临床社会工作者（CSW）为独立从业者是否是改善所需心理健康服务可及性的一种具有成本效益的方法。尽管与精神科医生相比，CSW服务成本较低，但该示范项目对服务可及性几乎没有影响，也没有明确的节省成本的证据。然而，CSW和精神科医生在治疗模式和治疗环境方面的差异表明，对于一些患者来说，CSW可能是合适的替代护理来源。
