McNeese-Smith D K
Nursing Administration Graduate Program, School of Nursing, University of California, Los Angeles 90095, USA.
Psychiatr Serv. 1998 Oct;49(10):1323-9. doi: 10.1176/ps.49.10.1323.
This study sought information about the effect of managed care on substance abuse treatment programs through a survey of program directors.
Fifty program directors who supervised a total of 134 substance abuse treatment programs in Los Angeles County completed a survey during the period from January to May 1997 on program changes made in response to managed care, major concerns, the advantages and disadvantages of managed care, and plans for further program changes to succeed in the managed care environment.
Program directors reported that the most frequent change made in response to managed care was increased outreach and marketing. Their greatest concern in the managed care environment was being forced to provide the least costly service, rather than the best care for patients. Respondents identified an increased focus on outcomes as an advantage of managed care and restrictions on services due to contractual agreements as a disadvantage. Planned program changes addressed the areas of program structure, types of programs offered, staff composition, revenue generation, referral sources, prevention, outcome measures, relationships with other organizations, and accreditation and certification.
Although some substance abuse treatment programs seem to be reducing their scope or preparing to close in response to managed care, others are developing strategies to survive and even thrive in this new economic environment.
本研究通过对项目主管进行调查，探寻管理式医疗对药物滥用治疗项目的影响。
50位主管在洛杉矶县共监管134个药物滥用治疗项目，他们于1997年1月至5月期间完成了一项关于因应管理式医疗而做出的项目变动、主要担忧、管理式医疗的优缺点以及为在管理式医疗环境中取得成功而进一步进行项目变动的计划的调查。
项目主管报告称，因应管理式医疗而做出的最常见变动是加强外展和营销。他们在管理式医疗环境中最担忧的是被迫提供成本最低的服务，而非为患者提供最佳护理。受访者认为管理式医疗的一个优点是更加注重结果，而缺点是因合同协议导致服务受限。计划中的项目变动涉及项目结构、提供的项目类型、人员构成、创收、转诊来源、预防、结果衡量、与其他组织的关系以及认证等领域。
尽管一些药物滥用治疗项目似乎因应管理式医疗而在缩小规模或准备关闭，但其他项目正在制定策略以在这种新的经济环境中生存甚至发展壮大。
