How do HMOs reduce outpatient mental health care costs?
How do HMOs reduce outpatient mental health care costs?
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HMO 如何降低门诊心理保健费用？
DOI：
10.1176/ajp.148.1.96
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
Wells,KB
中科院分区：
文献类型：
--
作者：
Norquist,GS;Wells,KB
由于以前对精神卫生保健服务利用差异的研究有重要的局限性，目前尚不清楚他们的研究结果，即健康维护组织（HMO）门诊精神卫生保健费用低于按服务收费的医疗费用，是由于获得较少，每位用户的重症监护较少，还是HMO选择性地招募了更健康的人。因此，作者使用的数据，从国家精神卫生研究所流行病学集水区（ECA）的研究，以检查精神疾病的患病率和差异在使用门诊心理健康服务的成年人参加HMO或收费服务的健康保险plans.MethodThe科目是ECA社区样本从东洛杉矶和西洛杉矶。该样本包括大量西班牙裔受试者。受试者根据他们对5项保险的反应进行分类，包括医疗保险登记者、私人收费服务计划成员、医疗补助登记者、HMO成员和未投保者。通过使用NIMH诊断访谈表确定是否存在精神疾病。用户和非用户的心理健康services.ResultsThe HMO和收费服务计划有类似的患病率的精神疾病和类似的专业精神卫生保健。然而，HMO登记者有显着减少访问每个用户提供的专业care.ConclusionsThe最有可能的解释为降低心理健康护理费用在HMO是一个不太密集的风格的护理为一个精神病患者的人口。
ObjectiveBecause previous studies of differences in utilization of mental health care services have had important limitations, it is not clear if their findings that health maintenance organization (HMO) outpatient mental health care costs less than fee-for-service care are due to less access, less intensive care per user, or selective enrollment of healthier people by HMOs. Therefore, the authors used data from the National Institute of Mental Health Epidemiologic Catchment Area (ECA) study to examine differences in the prevalence of psychiatric disorder and differences in the use of outpatient mental health services for adults enrolled in HMO or fee-for-service health insurance plans.MethodThe subjects were an ECA community sample obtained from East Los Angeles and West Los Angeles. This sample included a large number of Hispanic subjects. The subjects were categorized according to their responses to a 5-item battery on insurance as Medicare enrolles, members of private fee-for-service plans, Medicaid enrollees, members of an HMO, and uninsured. The presence or absence of psychiatric disorders was determined by using the NIMH Diagnostic Interview Schedule. Both users and nonusers of mental health services were studied.ResultsThe HMO and fee-for-service plans had similar prevalence of psychiatric disorder and similar access to specialty mental health care. However, HMO enrollees had significantly fewer visits per user to providers of specialty care.ConclusionsThe most likely explanation for lower mental health care costs in HMOs is a less intensive style of care for a comparably sick population.