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Options for providing health care for the uninsured: opportunities for managed care.

Journal of health & social policy 1989年第1期1卷 61-73页

作者： Fritz, D.L. Center for Prepaid Health Care Research Rockville 20851. MD United States

The problem of providing health care for the uninsured has regained national attention. A variety of approaches are being tried across the country including State High Risk Pools and other insurance pools, increased individual policy options, and expansion of Medicaid and Medical Assistance eligibility. One of the key design elements in these approaches often is the use of managed care. A review of important design features and risk factors is presented. Findings from a welfare-to-work demonstration project are described including enrollees who lose Medicaid but do not have employer based health benefits.

关键词：家庭抚养子女补助数据收集人口统计学筹资组织分保集团/组织和管理管理医疗规划/组织和管理医疗费用无力承担试点项目贫困美国

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Managing Alzheimer's disease in the new health care economy

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ADMINISTRATION AND POLICY IN MENTAL HEALTH 2003年第3期30卷 267-273页

作者： Kettl, P Penn State Univ Milton S Hershey Med Ctr Coll Med Dept Psychiat H073 Hershey PA 17033 USA

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Families as full research partners: What's in it for us?

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 1999年第3期26卷 329-344页

作者： Vander Stoep, A Williams, M Jones, R Green, L Trupin, E Univ Washington Childrens Hosp & Med Ctr Div Child & Adolescent Psychiat Seattle WA 98105 USA King Cty Federat Families Renton WA USA Puget Sound Educ Serv Dist Burien WA 98166 USA

This article describes a children's managed mental health care program that incorporates both a family participation service model and a family-initiated evaluation model. The authors begin by tracing the evolution of the family support and the participatory research movements leading to current developments in children's mental health services research. In the King County Blended Funding Project, three service systems pool funds that are spent flexibly by child and family teams. Family advocates have led efforts to design and implement the project evaluation. During this process, many tensions have arisen between meeting the demands of both scientific rigor and multiple community stakeholders. Examples are given of the issues raised by family advocates and research scientists as together they established a theory of change, identified meaningful outcomes, selected measurement tools, and implemented the evaluation protocol. Guidelines are given for how services research partnerships can be successfully built to better address community needs. This article was selected as a distinguished research paper based on a presentation by the authors at the 1998 11th annual research conference titled "A System of Care for Children's Mental Health: Expanding the Research Base." This conference is sponsored annually by the Research and Training Center for Children's Mental Health, Department of Child and Family Studies, Louis de Ea Parte Florida Mental Health Institute, University of South Florida, Tampa.

关键词：儿童保健服务/组织和管理儿童福利社区网络用户参与/方法家庭/心理学管理医疗规划/组织和管理精神卫生服务/组织和管理模型组织管理组织改革以病人为中心医护/组织和管理方案评价/方法华盛顿儿童人类

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Workplace managed care: Collaboration for substance abuse prevention

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 2000年第2期27卷 125-130页

作者： Galvin, DM Substance Abuse & Mental Hlth Serv Adm Ctr Substance Abuse Prevent Div Workplace Programs Gaithersburg MD 20878 USA

This article describes the history, purpose, and overall methodology of the Workplace Managed Care (WMC) study sponsored by the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention (CSAP). This study was initiated to discern best practices for workplaces and managed care organizations integrating their substance abuse prevention and early intervention programs, strategies, and activities for employees and their families. CSAP funded nine WMC grants to study their retrospective and prospective data. Results of the WMC study suggested the addition of substance abuse prevention material to existing workplace health promotion offerings that resulted in improved substance abuse attitudes without jeopardizing existing health promotion programs. Stress management programming was successful at improving substance abuse attitudes indirectly. This study provides a platform for multidisciplinary research in workplace and managed care settings.

关键词：健康促进/方法管理医疗规划/经济学管理医疗规划/组织和管理模型组织管理职业卫生服务/立法和法学职业卫生服务/组织和管理物质相关性障碍/经济学物质相关性障碍/预防和控制美国工作场所/经济学工作场所/组织和管理人类

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HIV healthcare delivery and managed care: applications and implications from the Special Projects of National Significance Program.

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Home health care services quarterly 1998年第1期17卷 101-109页

作者： Gamliel, S. Singer, B. Marconi, K. Health Resources and Services Administration for Special Projects of National Significance Rockville MD United States

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关键词：按人收费 HIV感染/治疗管理医疗规划/经济学管理医疗规划/组织和管理 Medicaid/经济学 Medicaid/组织和管理模型组织管理试点项目卫生保健质量美国人类

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Implementing capitation of Medicaid mental health services in Colorado: Is "readiness" a necessary condition?

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JOURNAL OF BEHAVIORAL HEALTH SERVICES & RESEARCH 2000年第4期27卷 437-445页

作者： Bloom, JR Devers, K Wallace, NT Wilson, N Univ Calif Berkeley Berkeley CA 94720 USA Portland State Univ Mark Hatfield Sch Publ Policy Portland OR 97207 USA

Two consortia of community mental health centers in Colorado varied in their administrative readiness for changing to a capitated system and, ultimately, implemented capitation using different organizational arrangements. The objective was to assess the impact of this natural experiment on administrative change, costs, and utilization of services during the first two years postcapitation. prior to capitation, one was rated as having greater "readiness" than the other and received a capitation contract from the state, while the other did not. A private, for-profit managed behavioral health organization was awarded a contract and formed a joint venture with the less "ready" consortium, providing managed care expertise to complement the consortium's expertise in delivering mental health services. Two years later these consortia do not look different either administratively or in their patterns of service utilization and costs. These findings suggest alternative ways of successfully implementing a capitated public mental health system.

关键词：按人收费科罗拉多社区精神卫生服务/经济学社区精神卫生服务/组织和管理社区精神卫生服务/利用费用效益分析管理医疗规划/组织和管理 Medicaid 模型组织管理地区医疗规划/组织和管理美国利用情况审核人类

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Mental health carve-outs: Effects and implications

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Medical Care Research and Review 1999年第SUPPL. 2期56.0卷 37-59页

作者： Grazier, Kyle L. Eselius, Laura L. University of Michigan Harvard University

To control the rise in expenditures and to increase access to mental health and substance abuse (MH/SA) services, a growing number of employers and states are implementing a 'carve-out.' Under this arrangement, the sponsor separates insurance benefits by disease or condition, service category, or population and contracts separately for the management of care and/or associated risks. A carve-out allows a unique set of managed care techniques to be applied to a subset of particularly costly or complex benefits. This article describes various carve-out models, discusses the potential advantages and disadvantages of a full carve-out, and summarizes recent public and private sector research regarding the strategy's effects on access and use, cost savings and shifting, and quality of care. It concludes by discussing approaches to the assessment and monitoring of the processes and outcomes associated with a MH/SA carve-out.

关键词：合同业务/经济学费用控制疾病管理雇主承担保健费用/发展趋势保健福利计划雇员/经济学卫生服务易得程度管理医疗规划/组织和管理管理医疗规划/利用 Medicaid/经济学精神卫生服务/组织和管理精神卫生服务/利用生产线管理美国人类

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Primary health care in the reforms of the health care system: An analysis of reformation schemes of emerging and developing countries as applied to the republic of macedonia

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Health Marketing Quarterly 1999年第2期17卷 87-93页

作者： Goldman, Robert L. Health Care Management at Centerex Corporation University of California-Berkeley Extension Extension and Frederick Taylor University United States

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关键词：发展中国家伦理学医学医疗服务限制卫生保健改革/组织和管理卫生保健改革/标准卫生服务易得程度马其顿(共和国) 管理医疗规划/组织和管理初级卫生保健/组织和管理私有化社会正义

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Racial/ethnic disparities in admissions to public and private psychiatric inpatient settings: The effect of managed care

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ADMINISTRATION AND POLICY IN MENTAL HEALTH 1998年第2期26卷 101-109页

作者： Crawford, K Fisher, WH McDermeit, M Boston Univ Sch Med Div Psychiat Boston MA 02215 USA Univ Massachusetts Sch Med Dept Psychiat Amherst MA 01003 USA

This study investigates the effect of managed care on access patterns among people of color who are severely and persistently mentally ill. The distribution of admissions to public and private psychiatric hospitals was compared for African-American, Asian, Latino, and white case managed clients of the Massachusetts Department of Mental Health before and after implementation of Medicaid managed mental health care in October 1997. Managed care appears to have increased access to private services across all racial and ethnic groups, although admissions of non-white patients were still more likely to take place in publicly operated settings. These data suggest that equalizing access to putatively better inpatient treatment settings may be an externality of managed care.

关键词：大陆人口群人种群/统计学和数值数据卫生服务易得程度/标准卫生服务研究医院私立/利用医院精神病/利用医院公立/利用管理医疗规划/组织和管理马萨诸塞 Medicaid/组织和管理病人入院/统计学和数值数据美国成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Patterns of outpatient use of mental health services for medicaid beneficiaries under a prepaid mental health carve-out

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ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 1999年第6期26卷 401-415页

作者： Liu, CF Manning, WG Christianson, JB Stoner, T Lurie, N Gray, DZ Popkin, M Univ Minnesota Div Hlth Serv Res & Policy Sch Publ Hlth Minneapolis MN 55455 USA Hlth Econ Res Inc Waltham MA USA Univ Chicago Dept Hlth Studies Chicago IL 60637 USA Univ Utah Res & Evaluat Program Salt Lake City UT 84112 USA Hennepin Cty Med Ctr Dept Psychiat Minneapolis MN 55415 USA

This study examines the impact of a mental health carve-out, the Utah Prepaid Mental Health Plan (UPMHP), on use of outpatient mental health services by Medicaid beneficiaries with schizophrenia. Data were collected through interviews with the same group of Medicaid schizophrenic beneficiaries. A pre/post comparison with a contemporaneous control group examined the impact of the program on type of outpatient services used by beneficiaries. The results indicate a greater reliance on medically-oriented outpatient mental health services in treatment of beneficiaries under the UPMHP. Medicaid beneficiaries with schizophrenia in the UPMHP group received relatively fewer day treatment visits, but relatively more medication visits and individual therapy visits over the first 3 1/2 years of the program.

关键词：门诊医疗/经济学门诊医疗/利用按人收费社区精神卫生服务/经济学社区精神卫生服务/利用合同业务按诊疗收费计划随访研究管理医疗规划/组织和管理 Medicaid/组织和管理回归分析精神分裂症美国犹他成年人女(雌)性人类男(雄)性

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