Goldman W, McCulloch J, Sturm R
University of California, San Francisco, USA.
Health Aff (Millwood). 1998 Mar-Apr;17(2):40-52. doi: 10.1377/hlthaff.17.2.40.
This paper tracks access, utilization, and costs of mental health care for a private employer over nine years during which mental health benefits were carved out of the medical plan and managed care was introduced. Prior to the carve-out, mental health costs increased by around 30 percent annually; in the first year after the change, costs dropped by more than 40 percent; in the six follow-up years, costs continued to decline slowly. This cost reduction was not attributable to decreased initial access, as the number of persons using any mental health care increased following the change. Instead, the cost reduction was the result of (1) fewer outpatient sessions per user, (2) reduced probability of an inpatient admission, (3) reduced length-of-stay for an inpatient episode, and (4) substantially lower costs per unit of service.
本文追踪了一家私人雇主在九年间的心理健康护理的可及性、利用率和成本情况，在此期间，心理健康福利从医疗保险计划中分离出来，并引入了管理式医疗。在分离之前，心理健康成本每年增长约30%；在变革后的第一年，成本下降了40%以上；在随后的六年里，成本继续缓慢下降。这种成本降低并非归因于初始可及性的降低，因为变革后使用任何心理健康护理的人数有所增加。相反，成本降低是以下因素的结果：（1）每位用户的门诊次数减少；（2）住院收治的可能性降低；（3）住院期间的住院时长缩短；（4）每单位服务的成本大幅降低。
