Scheffler R, Grogan C, Cuffel B, Penner S
Center for Research on the Organization and Financing of Care for the Severely Mentally Ill, Western Consortium for Public Health, Berkeley, CA.
Hosp Community Psychiatry. 1993 Oct;44(10):937-42. doi: 10.1176/ps.44.10.937.
Many concerns have been raised about the special problems of providing care for severely mentally ill persons in a reformed health care system based on managed competition. The authors describe what will likely be basic features of the reformed system and discuss potential problems in serving this population. The authors recommend the development of special mental health maintenance organizations (MHMOs) that would serve only persons with severe mental illness. The MHMO would emphasize case management in the community and would provide a fixed point of responsibility for clinical care of these patients. Two methods of reimbursing MHMOs are proposed. Each region's health insurance purchasing cooperative (HIPC) could reimburse the MHMO on a capitated risk-adjusted basis. Alternatively, HIPCs could require the general health plan to operate or contract for MHMOs. In each case, the HIPC would provide quality-of-care oversight and assign a team to act as a gatekeeper for referrals to the MHMO.
对于在基于管理式竞争的改革后的医疗保健系统中为严重精神疾病患者提供护理的特殊问题，人们提出了许多担忧。作者描述了改革后系统可能的基本特征，并讨论了为这一人群提供服务时的潜在问题。作者建议发展专门的心理健康维护组织（MHMOs），这些组织将只服务于患有严重精神疾病的人。MHMO将强调社区病例管理，并为这些患者的临床护理提供固定的责任点。文中提出了两种偿付MHMO的方法。每个地区的健康保险购买合作社（HIPC）可以在按人头风险调整的基础上向MHMO偿付费用。或者，HIPC可以要求一般健康计划运营MHMO或与MHMO签订合同。在每种情况下，HIPC都将对护理质量进行监督，并指派一个团队作为转诊至MHMO的把关人。
