Who will pay for involuntary civil commitment under capitated managed care? An emerging dilemma.
Who will pay for involuntary civil commitment under capitated managed care? An emerging dilemma.
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谁将支付按人头管理医疗下的非自愿民事承诺费用？
DOI：
10.1176/ps.46.10.1045
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发表时间：
1995
影响因子：
3.8
通讯作者：
J. Petrila
中科院分区：
文献类型：
--
作者：
J. Petrila
在管理式医疗环境中，非自愿的民事收容可能会在医疗服务提供者和支付方之间产生冲突。医疗服务提供者可能判定一名患者，尤其是对自身或他人构成风险的患者，必须被收容的时间超过支付方所报销的期限。法院的判决支持了临床医生在这些情况下提供医疗服务的伦理责任。此外，民事收容可能被用于将长期护理的费用转嫁给另一个医疗服务提供者。作者探讨了这些问题，并提出了医疗服务提供者可以用来解决这些问题的六种策略。这些策略包括：通过确保与支付方签订的合同涉及民事收容以及有自伤或伤人风险的患者，避免就个别患者的医疗护理与支付方进行谈判；确定并创建服务和社会支持以减少收容的必要性，并允许创造性地使用福利；采用正式的风险评估方案，使所有患者和临床医生的流程标准化；对管理式医疗环境中民事收容和强制手段的使用进行研究；确保州医疗补助管理式医疗计划中不存在利用民事收容转移成本的激励措施；与治疗人员就财务考虑因素日益侵入治疗决策进行讨论。
Involuntary civil commitment in managed care settings may create conflicts between providers and payers. Providers may determine that a patient, particularly one who presents a risk to self or others, must be confined beyond the period reimbursed by the payer. Court decisions have upheld clinicians' ethical obligations to provide care in these situations. In addition, civil commitment may be used to shift costs of long-term care to another provider. The author explores these issues and suggests six strategies that providers can use to address them. They include avoiding negotiations with payers over individual patients' care by ensuring that contracts with payers address civil commitment and patients at risk of harming themselves or others, identifying and creating services and social supports to reduce the necessity for commitment and allowing creative use of benefits, adopting formal risk assessment protocols to standardize the process for all patients and and clinicians, conducting research on the use of civil commitment and coercion in managed care settings, ensuring that incentives do not exist in states' Medicaid managed care programs to use civil commitment to shift costs, and holding discussions with treatment staff about the growing encroachment of financial considerations into treatment decisions.
管理精神卫生保健：20 世纪 90 年代的神话与现实。
DOI：
10.1176/ps.41.10.1087
发表时间：
1990
期刊：
Hospital & community psychiatry
影响因子：
--
作者：
Dorwart,RA
通讯作者：
Dorwart,RA