COST SHARING AND PAYMENT POLICY FOR MENTAL HEALTH

本项目将审查费用分摊政策对 心理健康服务使用者的行为，检查影响 支付政策对精神健康提供者行为的影响 服务;并研究如何将这两项政策结合起来 仪器. 其目的是描述“最优” 提供最大利益的报销政策 为病人提供一定水平的精神健康资源， 系统 私营部门和政府最近的变化 这种服务的偿还一般是在 增加精神卫生成本和风险的方向 用户和供应商。 了解用户和提供商如何 对这些变化做出反应，预测任何可能 结果，并提出适当的政策选择将是 这是拟议研究的主要目标。 第一项研究工作是开发一个概念模型， 心理健康对报销制度作出反应， 利用该模型预测各种补偿的影响， 供应商行为的政策选择。 这项工作将建立在 Ellis和McGuire（1986 b）最近的概念性工作， 检查医生对患者住院时间的选择 根据预期付款。 第二项研究工作是估计一些关键的 反映供应商对报销的响应的参数 系统 这些可能包括病人转移率的变化， 住院时间或再入院 供应商的反应将是 估计使用医疗保险索赔文件或两个之一 私人保险公司索赔档案 第三项研究工作是开发和评估一个结构 消费者对需求方费用分担的共鸣模型。 一 结构模型意味着消费者参数 响应函数将被估计，可以应用于其他 设置. 而不是估计整个 保险计划，注意个人计划 特征以及它们如何影响需求。 第四项研究工作是整合需求侧成本- 与供应方支付机制共享政策。 预期付款是一种相对较新的政策工具。 考虑到其对护理模式的影响， 预期付款与传统的需求方费用分摊 是健康和精神健康政策的一项重要任务， 施政纲要的演讲 本工作将综合上述三个方面的成果 努力

This project will examine the impact of cost-sharing policy on the behavior of users of mental health services, examine the impact of payment policy on the behavior of providers of mental health services; and investigate ways to integrate the two policy instruments. The purpose is to characterize the "optimal" reimbursement policy that which provides the maximum benefits to patients for a given level of resources to the mental health system. Recent changes in private and government reimbursement of such services have generally been in the direction of increasing the costs and risks borne by mental health users and providers. Understanding how users and providers respond to these changes, predicting any cost savings that may result, and suggesting appropirate policy alternatives will be the primary goal of the proposed research. The first research effort is to develop a conceptual model of mental health provide response to the reimbursement system, and to use the model to predict the impact of various reimbursement policy alternatives on provider behavior. The work will build upon the recent conceptual work in Ellis and McGuire (1986b) that examines the physicians choice of the length of stay for patients under prospective payment. The second research effort is to estimate some of the key parameters reflecting provider response to the reimbursement system. These might include changes in patient transfer rates, lengths of stay, or readmissions. Provider response will be estimated using either a Medicare claims file or one of two private insurer claims files. The third research effort is to develop and estimate a structural model of consumer resonse to demand-side const-sharing. A structural model implies that parameters of the consumer response functions will be estimated that can be applied to other settings. Rather than estimating the impact of an entire insurance plan, attention will be given to individual plan characteristics and how they affect demand. The fourth research effort is to integrate demand side cost- sharing policies with supply side payment mechanisms. Prospective payment is a relatively new policy instrument. Considering its impact on patterns of care, and integraing the role of prospective payment with traditional demand-side cost-sharing is an important task on the health and mental health policy agenda. This work will integrate the results from the above three efforts.