Grimes K E
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
J Assoc Acad Minor Phys. 1997;8(4):74-7.
This article reviews the tension between "gatekeeping," routinely practiced by managed care to limit utilization of care and, presumably, cost, and the increased demands of purchasers (such as Medicaid), consumer groups, and the National Council for Quality Assurance for mental health screening, outreach, and access to specialty care, particularly for vulnerable populations. Using examples from Harvard Pilgrim Health Care in Boston, the second oldest health maintenance organization in the country, the argument is advanced that early detection, coordination with primary care, and readily available expert consultation actually diminish cost while reducing morbidity and improving satisfaction.
本文回顾了管理式医疗通常实施的“把关”措施（旨在限制医疗服务的使用，并推测是为了控制成本）与购买方（如医疗补助计划）、消费者团体以及国家质量保证委员会对心理健康筛查、外展服务和获得专科护理（尤其是针对弱势群体）日益增长的需求之间的矛盾。以美国第二古老的健康维护组织——波士顿的哈佛朝圣者医疗保健公司为例，文章提出，早期发现、与初级保健协调以及随时可得的专家咨询实际上既能降低成本，又能减少发病率并提高满意度。
