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Cost Containment and Mental Health Outcomes: Experiences from US Studies

Published online by Cambridge University Press:  06 August 2018

Kenneth B. Wells
Kenneth B. Wells*
Affiliation:
Neuropsychiatric Hospital, Center for the Health Sciences, UCLA, 760 Westwood Plaza, Los Angeles, California 90024
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Abstract

Background. Cost containment mechanisms, such as prepayment, are being considered or implemented in the US and elsewhere, but there have been few studies of the effects of such mechanisms on quality or outcomes of care for individuals with serious psychiatric disorders.

Method. Key results from US studies on cost containment and their implications are reviewed.

Results. Cost savings in out-patient mental health care can be achieved through increasing the share of costs paid by the covered individual or through prepayment, but individuals with the greatest psychological distress or poor people may achieve worse outcomes under greater cost containment. Quality of care may be poorer under some forms of prepayment than under fee-for-service care, yet a national prospective payment mechanism for depressed elderly in-patients was not associated with a marked drop in quality or outcomes of care among those admitted.

Conclusions. Prepayment, relative to fee-for-service is not always associated with lower outcomes or quality of care for affective disorders. Under cost containment, quality and outcomes of care, especially for the sick poor, should be monitored to identify adverse consequences.

Information

Type
III. Economic Aspects of Programmes Dealing with Depressive Disorders
Information
The British Journal of Psychiatry , Volume 166 , Issue S27: Economics of Anxiety and Depression , April 1995 , pp. 43 - 51
Copyright
Copyright © 1995 The Royal College of Psychiatrists 

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References

American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
Burnam, M. A., Wells, K. B., Leake, B., et al (1988) Development of a brief screening instrument for detecting depressive disorders. Medical Care, 26, 775–789.Google Scholar
Davis, L. M., Buchanan, J. L. & Wells, K. B. (1993) PPS and TEFRA effects on charges for treatment of depression. Advances in Health Economics and Health Services Research, 14, 1987–2104. JAI Press.Google Scholar
Donaldson, C. & Gerard, K. (1991) Minding our Ps and Qs? Financial incentives for efficient hospital behavior. Health Policy, 17, 5–76.Google Scholar
Draper, D., Kahn, K. L., Reinisch, E. F., et al (1990) Studying the effects of the DRG-based prospective payment system on quality of care: Design, sampling, and fieldwork. Journal of the American Medical Association, 264, 1956–1961.Google Scholar
Duckett, S. J. (1987) Management and planning uses of diagnosis related groups: Report of a study tour to England, France, and the United States of America. Australian Health Review, 10, 102–117.Google Scholar
Ellwood, P. (1988) Outcomes management: A technology of patient experience. New England Journal of Medicine, 318, 1549–1556.Google Scholar
Frank, R. G. & Mcguire, T. G. (1986) A review of studies of the impact of insurance on the demand and utilization of specialty mental health services. Health Services Research, 21, 241–266.Google Scholar
Kahn, K., Rubenstein, L. V., Draper, D., et al (1990) The effects of DRG-based prospective payment system on quality of care for hospitalized Medicare patients: An introduction to the series. Journal of the American Medical Association, 264, 1953–1955.Google Scholar
Keeler, E. B., Manning, W. G. & Wells, K. B. (1988) The demand for episodes of mental health services. Journal of Health Economics, 7, 369–392.Google Scholar
Keeler, E. B. & Rolph, J. E. (1988) The demand for episodes of treatment in the Health Insurance Experiment. Journal of Health Economics, 7, 337–367.Google Scholar
Keeler, E. B., Wells, K. B., Manning, W. G., et al (1986) The demand for episodes of mental health services. R-3432-NIMH (The RAND Corporation, Santa Monica, CA).Google Scholar
Lurie, N., Moscovice, I., Finch, M., et al (1992) Does capitation affect the health of the chronically mentally-ill: Results from a randomized trial. Journal of the American Medical Association, 267, 3300–3304.Google Scholar
Newhouse, J. P., Manning, W. G., Morris, C. N., et al (1981) Some interim results from a controlled trial of cost sharing in health insurance. New England Journal of Medicine, 305, 1501–1507.Google Scholar
Petchey, R. (1987) Health maintenance organizations: just what the doctor ordered? Journal of Social Policy, 16, 489–507.Google Scholar
Robins, L. N., Helzer, J. E., Croughan, J., et al (1987) National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Archives of General Psychiatry, 38, 381–389.Google Scholar
Rogers, W. H., Wells, K. B., Meredith, L. S., et al (1993) Outcomes for adult depressed outpatients under prepaid or fee-for-service financing. Archives of General Psychiatry, 50, 517–525.Google Scholar
Tarlov, A., Ware, J. E. Jr, Greenfield, S., et al (1989) The Medical Outcomes Study: an application of methods for monitoring the results of medical care. Journal of the American Medical Association, 262, 925–930.Google Scholar
Veit, C. T. & Ware, J. E. Jr (1983) The structure of psychological distress and well-being in general populations. Journal of Consulting Clinical Psychology, 51, 730–742.Google Scholar
Wells, K. B. & Burnam, M. A. (1991) Caring for depression in America: Lessons learned from early findings of the Medical Outcomes Study. Psychiatric Medicine, 9, 503–519.Google Scholar
Wells, K. B., Burnam, M. A., Rogers, W., et al (1992) The course of depression in adult outpatients: Results from the Medical Outcomes Study. Archives of General Psychiatry, 49, 788–794.Google Scholar
Wells, K. B., Hays, R. D., Burnam, M. A. (1989) Detection of depressive disorder for patients receiving prepaid or fee-for-service care: Results from the Medical Outcomes Study. Journal of the American Medical Association, 262, 3298–3302.Google Scholar
Wells, K. B., Kosecoff, J., Sherwood, M., et al (1988) Medical Record Abstraction Form and Guidelines for Assessing Quality of Care for Hospitalized Patients with Depression. The RAND Corporation, N-2803-HCFA.Google Scholar
Wells, K. B., Manning, W. G. & Benjamin, B. (1986) Use of outpatient mental health services in HMO and fee-for-service plans: Results from a randomized controlled trial. Health Services Research, 21, 453–474.Google Scholar
Wells, K. B., Manning, W. G. & Valdez, R. B. (1989) The effects of insurance generosity on the psychological distress and psychological well-being of a general population. Archives of General Psychiatry, 46, 315–320.Google Scholar
Wells, K. B., Manning, W. G. & Valdez, R. B. (1990) The effects of a prepaid group practice on mental health outcomes. Health Services Research, 25, 615–625.Google Scholar
Wells, K. B., Rogers, W. H., Davis, L.M., et al (1993) Quality of care for hospitalized depressed elderly before and after implementation of a national prospective payment system. American Journal of Psychiatry, 50, 1799–1805.Google Scholar
Wells, K. B., Stewart, A., Hays, , et al (1989) The functioning and well-being of depressed patients: Results from the Medical Outcomes Study. Journal of the American Medical Association, 262, 914–919.Google Scholar
Wiley, M. M. (1988) DRGs as a basis for prospective payment. Health Policy, 9, 157–165.Google Scholar
World Health Organization (1978) Mental Disorders: Glossary and Guide to their Classification in Accordance with the Ninth Revision of the International Classification of Diseases (ICD-9). Geneva: WHO.Google Scholar
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