Incentives for Community Treatment Mental Illness Management Services
Incentives for Community Treatment Mental Illness Management Services
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社区治疗精神疾病管理服务的激励措施
DOI：
10.1097/00005650-199507000-00008
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发表时间：
1995
期刊：
影响因子：
3
通讯作者：
T. Ackerson
中科院分区：
文献类型：
--
作者：
R. Clark;R. Drake;G. McHugo;T. Ackerson
在社区环境中为患有精神疾病和其他慢性病的人提供服务可能会提高治疗的依从性和满意度，但现有的支付机制往往倾向于以办公室为基础的治疗。这项研究考察了医疗补助支付方式的变化对病例经理提供的服务的地点和数量的影响。治疗提供者在社区环境和精神健康中心向185名客户提供的服务量进行了比较，报销前和报销后从全覆盖的预期费率改为混合的预期/追溯付款。客户参加了两个不同的治疗计划：一个是经过广泛体内治疗培训的持续治疗小组，另一个是强调以办公室为基础的治疗的病例管理计划。社区服务增加，办公室治疗量减少。持续治疗小组增加的社区服务多于病例管理人员；病例管理人员减少了基于办公室的治疗。提供的服务总量没有变化。结论是，前瞻性和追溯性混合报销可以消除社区治疗的经济障碍，但与培训计划结合使用效果最好。需要进行更多研究，以确定此类变化的确切财务影响。
Serving people with mental and other chronic illnesses in community settings may improve compliance and satisfaction with treatment, but existing payment mechanisms often favor office-based treatment. This study examines the effect of a change in Medicaid payment on the location and amount of service provided by case managers. Amounts of service given by treatment providers to 185 of their clients in community settings and in mental health centers were compared before and after reimbursement changed from an all-inclusive prospective rate to a mixed prospective/retrospective payment. Clients were enrolled in two different treatment programs: continuous treatment teams with extensive training in in vivo treatment, and a case management program that emphasized office-based treatment. In-community service increased, and the amount of office-based treatment decreased. Continuous treatment teams increased in-community services more than case managers did; case managers decreased office-based treatment more. There was no change in total amount of services provided. It was concluded that mixed prospective and retrospective reimbursement can remove financial barriers to in-community treatment, but it works best in combination with a training program. Additional research is needed to determine the precise financial impact of such changes.