MANAGING MENTAL HEALTH CARE IN HMO

拟议中的研究旨在扩大对自然的认识， 健康维护组织（HMO） 组织和提供心理健康领域的服务， 酒精、药物滥用和心理健康（ADM）。委员会特别关切的 与旨在管理环境的战略的执行和影响有关的 HMO中精神卫生保健的利用率和成本。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健康维护组织进行了调查 收集1985年关于ADM福利、交付系统、人员配置模式的数据， 治疗模式、转诊途径、利用率、支付机制，以及 成本拟议的研究包括1988年对健康维护组织进行调查 包括心理健康和综合ADM服务，这使得比较 1988年关于交付办法、利用和费用的调查结果， 从1985年的调查，以及从以前的研究进行的数据， 他人此外，对1988年的 将进行有关精神保健的调查数据。此外 根据调查结果，该分析将纳入健康维护组织的数据 InterStudy的纵向国家HMO数据库的特征， 来自地区资源文件的社区卫生相关统计数据， 根据规定的ADM福利和医院费率规定， 对州监管机构进行电话调查， 通过电话领取十字/蓝盾精神健康福利 调查.这部分的数据分析是由一个“战略”指导的。 适应”的概念框架，借鉴了理论和经验， 社会学和经济学领域的工作。它将审查 （a）具体的组织管理战略之间的关系 心理健康服务和一组独立变量，包括HMO 和环境特征，以及（B）这些组织之间 战略和精神卫生保健的利用和成本，控制 其他相关因素。该研究的产品包括详细的 描述性调查结果的报告，包括1985- 1988年的比较;图表 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 美国国家心理研究所向其他研究人员提供 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.