MANAGING MENTAL HEALTH CARE IN HMO

拟议的研究旨在扩大对自然界和 健康维护组织(HMO)方式的决定因素 组织和提供心理健康领域的服务 酒精、药物滥用和精神健康(ADM)。特别令人担忧的是 关于实施和影响旨在管理 保健机构中精神卫生服务的利用和费用。这项研究建立了 直接基于合同#278-86-0019(BA)支持的先前研究 NIMH，调查人员在全国范围内对医疗保健组织进行了调查 收集1985年关于ADM福利、交付系统、人员配置模式、 治疗方式、转诊路径、使用率、支付机制以及 成本。这项拟议的研究包括在1988年对医疗保健组织进行调查。 涵盖精神健康和综合ADM服务，允许进行比较 1988年关于交付方法、利用率和成本的调查结果 来自1985年的调查，以及来自 其他。此外，对1988年的更密集的多变量分析 将进行与精神卫生保健有关的调查数据。此外 对于调查的答复，这项分析将纳入有关HMO的数据 来自InterStudy纵向国家HMO数据库的特征， 来自地区资源文件、数据的社区卫生相关统计数据 将根据强制的ADM福利和医院费率规定进行收集 对州监管机构进行电话调查，并提供有关Blue的数据 十字/蓝盾精神健康福利将通过电话收集 调查。数据分析的这一部分是由“战略”指导的 借鉴理论和经验的“适应”概念框架 来自社会学和经济学领域的研究。它将检查 (A)用于管理的具体组织战略之间的关系 精神健康服务和包括HMO在内的一组自变量 和环境特征，以及(B)在这些组织之间 策略和精神卫生保健的利用和费用，控制 其他相关因素。本研究的产品包括详细的 描述性调查结果报告，包括1985-88年的比较；图表 概述了调查结果；一系列专业出版物；以及 包含1985年和1988年数据的完整记录磁带将被制作 由国家心理研究所提供给其他研究人员 健康。

The proposed research seeks to expand knowledge of the nature and determinants of ways in which health maintenance organizations (HMOs) organize and deliver services in the areas of mental health and combined alcohol, drug abuse, and mental health (ADM). It is particularly concerned with the implementation and impact of strategies directed at managing the utilization and cost of mental health care in HMOs. This study builds directly on previous research supported by contract #278-86-0019(BA) from the NIMH, in which the investigators conducted a nationwide survey of HMOs to collect 1985 data on ADM benefits, delivery systems, staffing patterns, treatment modalities, referral paths, utilization, payment mechanisms, and costs. The proposed research includes conducting a 1988 survey of HMOs covering mental health and combined ADM services, which permits comparisons of findings on delivery approaches, utilization, and costs in 1988 to those from the 1985 survey, as well as to data from previous studies conducted by others. In addition, a more intensive multivariate analysis of the 1988 survey data pertaining to mental health care will be conducted. In addition to the survey responses, this analysis will incorporate data on HMO characteristics from InterStudy's longitudinal national HMO data base, health-related statistics on communities from the Area Resource File, data to be collected on mandated ADM benefits and hospital rate regulation by conducting a telephone survey of state regulators, and data on Blue Cross/Blue Shield mental health benefits to be collected by telephone survey. This part of the data analysis is guided by a "strategic adaptation" conceptual framework that draws on theoretical and empirical work from the fields of sociology and economics. It will examine relationships (a) between specific organizational strategies for managing mental health services and a set of independent variables that include HMO and environmental characteristics, and (b) between these organizational strategies and the utilization and costs of mental health care, controlling for other relevant factors. Products of the research include a detailed report of descriptive findings, including 1985-88 comparisons; a chartbook that summarizes the findings; a series of professional publications; and a fully documented tape containing the 1985 and 1988 data to be made available to other investigators by the National Institute of Mental Health.