Stroul B A, Pires S A, Katz-Leavy J W, Goldman S K
Management and Training Innovations in McLean, Virginia.
Hosp Community Psychiatry. 1994 Sep;45(9):877-82. doi: 10.1176/ps.45.9.877.
Lack of adequate insurance coverage is one reason that the percentage of children who currently utilize mental health services is significantly lower than the estimated percentage of children with serious mental disorders. Principles of a reformed health care system with particular relevance for children's mental health services include coverage of a broad array of home- and community-based services, provision of organized systems of care for children with serious and persistent mental illness, mechanisms to ensure appropriate utilization of services, and provision of mental health services on the same terms and conditions as other health services. The Clinton Administration's proposed Health Security Act embodied many of these principles. In addition, its call for universal coverage and for elimination of insurance exclusions for preexisting conditions would extend mental health coverage to children who are currently uninsured or underinsured; the plan would also expand the range of services covered to include state-of-the-art approaches such as intensive nonresidential services and other alternatives to hospitalization. Implementation of the proposed plan would require developing the service and workforce capacity to provide a full continuum of services, ensuring availability of existing services, integrating existing and new systems of care, guarding against underserving children with serious mental illness, and planning for the role of Medicaid funding in the reformed health care system.
缺乏足够的保险覆盖范围是目前使用心理健康服务的儿童比例显著低于患有严重精神障碍儿童估计比例的一个原因。经过改革的医疗保健系统中，与儿童心理健康服务特别相关的原则包括涵盖广泛的基于家庭和社区的服务、为患有严重和持续性精神疾病的儿童提供有组织的护理系统、确保服务合理利用的机制，以及与其他健康服务相同的条款和条件提供心理健康服务。克林顿政府提议的《健康安全法案》体现了其中许多原则。此外，该法案呼吁全民覆盖并消除对既往病症的保险排除，这将把心理健康覆盖范围扩大到目前未参保或保险不足的儿童；该计划还将扩大所涵盖的服务范围，包括诸如强化非住院服务和其他替代住院治疗的先进方法。实施提议的计划将需要发展服务和劳动力能力，以提供全面的连续服务，确保现有服务的可及性，整合现有和新的护理系统，防止患有严重精神疾病的儿童得不到充分服务，并规划医疗补助资金在改革后的医疗保健系统中的作用。
