Pub Date : 1999-03-01DOI: 10.1002/(SICI)1099-176X(199903)2:1<43::AID-MHP36>3.0.CO;2-7
W. Cartwright
{"title":"Methods for the economic evaluation of health care programmes, second edition. By Michael F. Drummond, Bernie O'Brien, Greg L. Stoddart, George W. Torrance. Oxford: Oxford University Press, 1997.","authors":"W. Cartwright","doi":"10.1002/(SICI)1099-176X(199903)2:1<43::AID-MHP36>3.0.CO;2-7","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199903)2:1<43::AID-MHP36>3.0.CO;2-7","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"22 1","pages":"43-43"},"PeriodicalIF":1.6,"publicationDate":"1999-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84685267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-01-29DOI: 10.1002/(SICI)1099-176X(199812)1:4<189::AID-MHP24>3.0.CO;2-W
Michael F. Hogan
BACKGROUND: In the United States, there is an uneasy division of responsibility for financing mental health care. For most illnesses, employer-sponsored health insurance and the large federal health insurance programs (Medicare, Medicaid) cover the costs of care. However, most employer-sponsored plans and Medicare provide only limited coverage for treatment of mental illness. A possible cause and result of this limited coverage in mental health is that states, and in some cases local (county) governments, finance a separate system of mental health care. This separate "public mental health system" provides a "safety net" of care for indigent individuals needing mental health care. However, there are potential negative consequences of maintaining separate systems. Continuity of treatment between systems may be impaired, and costs may be higher due to duplicate administrative costs. Maintaining a separate system managed by government may exacerbate the stigma associated with mental illness treatment. Most significantly, since eligibility for care may be linked to poverty status, and since having a serious mental illness may preclude regaining private coverage, maintaining a separate system may contribute to the poverty rate among persons with mental illnesses. AIMS OF THE PAPER: These potential problems have not been widely considered, perhaps because other problems and controversies in mental health care have captured our attention. In particular, controversies over deinstitutionalization in mental health have dominated the policy debate, especially when linked to related problems. These have included conflicts over authority and financial responsibility among federal, state and local governments, sensationalized media coverage of incidents involving people with mental illness, problems with siting community facilities, concern about mental illness among prisoners and the like. However, with the substantial reform of public mental health care in some states and localities, it is now possible to consider the implications of public and private integration. This paper considers such an approach. METHODS: This paper addresses the question of public and private integration, considering the state of Ohio as a case study. Ohio is a large state (population 11.2 million) and shares demographic, cultural and political characteristics with many other states. Ohio's successful experience implementing community mental health reform makes it a good candidate to use in evaluating issues in the potential integration of insurance-paid and public mental health care. RESULTS: The analysis indicates that the resources now used in Ohio's public system may be sufficient to support insurance financing of inpatient and ambulatory mental health treatment (the types of health care usually paid by insurance) while maintaining supportive services (e.g. housing, crisis care) as a residual safety net. DISCUSSION: At the current time, these resources are in state and local menta
{"title":"The public sector and mental health parity: time for inclusion","authors":"Michael F. Hogan","doi":"10.1002/(SICI)1099-176X(199812)1:4<189::AID-MHP24>3.0.CO;2-W","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199812)1:4<189::AID-MHP24>3.0.CO;2-W","url":null,"abstract":"BACKGROUND: In the United States, there is an uneasy division of responsibility for financing mental health care. For most illnesses, employer-sponsored health insurance and the large federal health insurance programs (Medicare, Medicaid) cover the costs of care. However, most employer-sponsored plans and Medicare provide only limited coverage for treatment of mental illness. A possible cause and result of this limited coverage in mental health is that states, and in some cases local (county) governments, finance a separate system of mental health care. This separate \"public mental health system\" provides a \"safety net\" of care for indigent individuals needing mental health care. However, there are potential negative consequences of maintaining separate systems. Continuity of treatment between systems may be impaired, and costs may be higher due to duplicate administrative costs. Maintaining a separate system managed by government may exacerbate the stigma associated with mental illness treatment. Most significantly, since eligibility for care may be linked to poverty status, and since having a serious mental illness may preclude regaining private coverage, maintaining a separate system may contribute to the poverty rate among persons with mental illnesses. AIMS OF THE PAPER: These potential problems have not been widely considered, perhaps because other problems and controversies in mental health care have captured our attention. In particular, controversies over deinstitutionalization in mental health have dominated the policy debate, especially when linked to related problems. These have included conflicts over authority and financial responsibility among federal, state and local governments, sensationalized media coverage of incidents involving people with mental illness, problems with siting community facilities, concern about mental illness among prisoners and the like. However, with the substantial reform of public mental health care in some states and localities, it is now possible to consider the implications of public and private integration. This paper considers such an approach. METHODS: This paper addresses the question of public and private integration, considering the state of Ohio as a case study. Ohio is a large state (population 11.2 million) and shares demographic, cultural and political characteristics with many other states. Ohio's successful experience implementing community mental health reform makes it a good candidate to use in evaluating issues in the potential integration of insurance-paid and public mental health care. RESULTS: The analysis indicates that the resources now used in Ohio's public system may be sufficient to support insurance financing of inpatient and ambulatory mental health treatment (the types of health care usually paid by insurance) while maintaining supportive services (e.g. housing, crisis care) as a residual safety net. DISCUSSION: At the current time, these resources are in state and local menta","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 4","pages":"189-198"},"PeriodicalIF":1.6,"publicationDate":"1999-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199812)1:4<189::AID-MHP24>3.0.CO;2-W","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71986006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-01-29DOI: 10.1002/(SICI)1099-176X(199812)1:4<199::AID-MHP22>3.0.CO;2-Z
Anthony F. Lehman
<p><b>Background</b>: Significant gaps exist between scientific knowledge about the efficacy of treatments for mental disorders and the availability of efficacious treatments in routine practice. Mental health service research can help bridge this gap between basic clinical research and the usual care afforded adults with mental disorders.</p><p><b> Aims</b>: To illustrate this potential, data on the efficacy of treatment for schizophrenia are reviewed.</p><p><b> Methods</b>: The treatments reviewed include pharmacotherapies, psychological interventions, family interventions, vocational rehabilitation and assertive community treatment and case management. Using treatment recommendations based upon outcome data about these treatments and the results of a large survey of usual care for schizophrenia from the Schizophrenia Patient Outcomes Research Team (PORT) project, examples of current deficiencies in the usual treatment of adult mental disorders and relevant questions that need to be addressed by mental health services research are identified.</p><p><b>Results</b>: Major deficiencies in treatment that were identified include inappropriate dosing with antipsychotic agents, underutilization of adjunctive antidepressant therapy, very low rates of prescription of psychosocial interventions and lack of continuity between inpatient and outpatient settings.</p><p><b>Discussion</b>: These findings raise serious concerns about access to care and the appropriateness and quality of care that is offered.</p><p><b> Implications</b>: This knowledge about what treatments work for schizophrenia and the patterns of current care suggest the following major questions be addressed by mental health services research: What is the nature of care currently being offered adults with mental disorders? To what degree does this care measure up to scientifically derived quality of care and treatment standards? What is the effectiveness of new technologies under usual practice conditions? For which patients are they cost-effective and under what conditions? How should financial incentives be structured within systems of care to promote the most cost-effective use of new technologies? How should service systems themselves be organized to promote appropriate access and utilization? What educational, organizational and financing interventions promote adoption of effective interventions? Do we have valid methods for assessing quality of care? What strategies (interventions) are effective at improving the quality of care? In addition, we need to develop strategies that transfer mental health services research technologies into practice. These include: (i) development of outcome measures that meet scientific standards and that are practical for general application in service systems to facilitate ‘outcome management’; (ii) development of quality of care assessment methodologies that are practical and scientifically sound and (iii) cost-effectiveness methodologies.</p><p>Mental hea
{"title":"The role of mental health service research in promoting effective treatment for adults with schizophrenia†","authors":"Anthony F. Lehman","doi":"10.1002/(SICI)1099-176X(199812)1:4<199::AID-MHP22>3.0.CO;2-Z","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199812)1:4<199::AID-MHP22>3.0.CO;2-Z","url":null,"abstract":"<p><b>Background</b>: Significant gaps exist between scientific knowledge about the efficacy of treatments for mental disorders and the availability of efficacious treatments in routine practice. Mental health service research can help bridge this gap between basic clinical research and the usual care afforded adults with mental disorders.</p><p><b> Aims</b>: To illustrate this potential, data on the efficacy of treatment for schizophrenia are reviewed.</p><p><b> Methods</b>: The treatments reviewed include pharmacotherapies, psychological interventions, family interventions, vocational rehabilitation and assertive community treatment and case management. Using treatment recommendations based upon outcome data about these treatments and the results of a large survey of usual care for schizophrenia from the Schizophrenia Patient Outcomes Research Team (PORT) project, examples of current deficiencies in the usual treatment of adult mental disorders and relevant questions that need to be addressed by mental health services research are identified.</p><p><b>Results</b>: Major deficiencies in treatment that were identified include inappropriate dosing with antipsychotic agents, underutilization of adjunctive antidepressant therapy, very low rates of prescription of psychosocial interventions and lack of continuity between inpatient and outpatient settings.</p><p><b>Discussion</b>: These findings raise serious concerns about access to care and the appropriateness and quality of care that is offered.</p><p><b> Implications</b>: This knowledge about what treatments work for schizophrenia and the patterns of current care suggest the following major questions be addressed by mental health services research: What is the nature of care currently being offered adults with mental disorders? To what degree does this care measure up to scientifically derived quality of care and treatment standards? What is the effectiveness of new technologies under usual practice conditions? For which patients are they cost-effective and under what conditions? How should financial incentives be structured within systems of care to promote the most cost-effective use of new technologies? How should service systems themselves be organized to promote appropriate access and utilization? What educational, organizational and financing interventions promote adoption of effective interventions? Do we have valid methods for assessing quality of care? What strategies (interventions) are effective at improving the quality of care? In addition, we need to develop strategies that transfer mental health services research technologies into practice. These include: (i) development of outcome measures that meet scientific standards and that are practical for general application in service systems to facilitate ‘outcome management’; (ii) development of quality of care assessment methodologies that are practical and scientifically sound and (iii) cost-effectiveness methodologies.</p><p>Mental hea","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 4","pages":"199-204"},"PeriodicalIF":1.6,"publicationDate":"1999-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199812)1:4<199::AID-MHP22>3.0.CO;2-Z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71986007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-01-29DOI: 10.1002/(SICI)1099-176X(199812)1:4<219::AID-MHP30>3.0.CO;2-Q
Ella Rytik
See PDF file for the abstracts translations in Russian.
见PDF文件的摘要翻译俄文。
{"title":"Abstracts translations","authors":"Ella Rytik","doi":"10.1002/(SICI)1099-176X(199812)1:4<219::AID-MHP30>3.0.CO;2-Q","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199812)1:4<219::AID-MHP30>3.0.CO;2-Q","url":null,"abstract":"<p>See PDF file for the abstracts translations in Russian.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 4","pages":"219-223"},"PeriodicalIF":1.6,"publicationDate":"1999-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199812)1:4<219::AID-MHP30>3.0.CO;2-Q","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71986003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-01-29DOI: 10.1002/(SICI)1099-176X(199812)1:4<205::AID-MHP25>3.0.CO;2-J
Darrel A. Regier MD,MPH
{"title":"Commentary","authors":"Darrel A. Regier MD,MPH","doi":"10.1002/(SICI)1099-176X(199812)1:4<205::AID-MHP25>3.0.CO;2-J","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199812)1:4<205::AID-MHP25>3.0.CO;2-J","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 4","pages":"205-207"},"PeriodicalIF":1.6,"publicationDate":"1999-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199812)1:4<205::AID-MHP25>3.0.CO;2-J","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71986001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-01-29DOI: 10.1002/(SICI)1099-176X(199812)1:4<173::AID-MHP23>3.0.CO;2-7
Sherry Glied, A. Bowen Garrett, Christina Hoven, Maritza Rubio-Stipec, Darrel Regier, Robert E. Moore, Sherryl Goodman, Ping Wu, Hector Bird
<p><b>Background</b>: Several recent studies of child outpatient mental health service use in the US have shown that having private insurance has no effect on the propensity to use services. Some studies also find that public coverage has no beneficial effect relative to no insurance.</p><p><b>Aims</b>: This study explores several potential explanations, including inadequate measurement of mental health status, bandwagon effects, unobservable heterogeneity and public sector substitution for private services, for the lack of an effect of private insurance on service use.</p><p><b> Methods</b>: We use secondary analysis of data from the three mainland US sites of NIMH’s 1992 field trial of the Cooperative Agreement for Methodological Research for Multi-Site Surveys of Mental Disorders in Child and Adolescent Populations (MECA) Study. We examine whether or not a subject used any mental health service, school-based mental health services or outpatient mental health services, and the number of outpatient visits among users. We also examine use of general medical services as a check on our results. We conduct regression analysis; instrumental variables analysis, using instruments based on employment and parental history of mental health problems to identify insurance choice, and bivariate probit analysis to examine multiservice use.</p><p><b> Results</b>: We find evidence that children with private health insurance have fewer observable (measured) mental health problems. They also appear to have a lower unobservable (latent) propensity to use mental health services than do children without coverage and those with Medicaid coverage. Unobserved differences in mental health status that relate to insurance choice are found to contribute to the absence of a positive effect for private insurance relative to no coverage in service use regressions. We find no evidence to suggest that differences in attitudes or differences in service availability in children’s census tracts of residence explain the non-effect of insurance. Finally, we find that the lack of a difference is not a consequence of substitution of school-based for office-based services. School-based and office-based specialty mental health services are complements rather than substitutes. School-based services are used by the same children who use office-based services, even after controlling for mental health status.</p><p><b>Discussion</b>: Our results are consistent with at least two explanations. First, limits on coverage under private insurance may discourage families who anticipate a need for child mental health services from purchasing such insurance. Second, publicly funded services may be readily available substitutes for private services, so that lack of insurance is not a barrier to adequate care. Despite the richness of data in the MECA dataset, cross-sectional data based on epidemiological surveys do not appear to be sufficient to fully understand the surprising result that insurance do
{"title":"Child outpatient mental health service use: why doesn’t insurance matter?","authors":"Sherry Glied, A. Bowen Garrett, Christina Hoven, Maritza Rubio-Stipec, Darrel Regier, Robert E. Moore, Sherryl Goodman, Ping Wu, Hector Bird","doi":"10.1002/(SICI)1099-176X(199812)1:4<173::AID-MHP23>3.0.CO;2-7","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199812)1:4<173::AID-MHP23>3.0.CO;2-7","url":null,"abstract":"<p><b>Background</b>: Several recent studies of child outpatient mental health service use in the US have shown that having private insurance has no effect on the propensity to use services. Some studies also find that public coverage has no beneficial effect relative to no insurance.</p><p><b>Aims</b>: This study explores several potential explanations, including inadequate measurement of mental health status, bandwagon effects, unobservable heterogeneity and public sector substitution for private services, for the lack of an effect of private insurance on service use.</p><p><b> Methods</b>: We use secondary analysis of data from the three mainland US sites of NIMH’s 1992 field trial of the Cooperative Agreement for Methodological Research for Multi-Site Surveys of Mental Disorders in Child and Adolescent Populations (MECA) Study. We examine whether or not a subject used any mental health service, school-based mental health services or outpatient mental health services, and the number of outpatient visits among users. We also examine use of general medical services as a check on our results. We conduct regression analysis; instrumental variables analysis, using instruments based on employment and parental history of mental health problems to identify insurance choice, and bivariate probit analysis to examine multiservice use.</p><p><b> Results</b>: We find evidence that children with private health insurance have fewer observable (measured) mental health problems. They also appear to have a lower unobservable (latent) propensity to use mental health services than do children without coverage and those with Medicaid coverage. Unobserved differences in mental health status that relate to insurance choice are found to contribute to the absence of a positive effect for private insurance relative to no coverage in service use regressions. We find no evidence to suggest that differences in attitudes or differences in service availability in children’s census tracts of residence explain the non-effect of insurance. Finally, we find that the lack of a difference is not a consequence of substitution of school-based for office-based services. School-based and office-based specialty mental health services are complements rather than substitutes. School-based services are used by the same children who use office-based services, even after controlling for mental health status.</p><p><b>Discussion</b>: Our results are consistent with at least two explanations. First, limits on coverage under private insurance may discourage families who anticipate a need for child mental health services from purchasing such insurance. Second, publicly funded services may be readily available substitutes for private services, so that lack of insurance is not a barrier to adequate care. Despite the richness of data in the MECA dataset, cross-sectional data based on epidemiological surveys do not appear to be sufficient to fully understand the surprising result that insurance do","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 4","pages":"173-187"},"PeriodicalIF":1.6,"publicationDate":"1999-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199812)1:4<173::AID-MHP23>3.0.CO;2-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71986005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-01-29DOI: 10.1002/(SICI)1099-176X(199812)1:4<153::AID-MHP20>3.0.CO;2-M
Richard G. Frank, Thomas G. Mcguire
Background: Parity in insurance coverage for mental health and substance abuse has been a key goal of mental health and substance abuse care advocates in the United States during most of the past 20 years. The push for parity began during the era of indemnity insurance and fee for service payment when benefit design was the main rationing device in health care. The central economic argument for enacting legislation aimed at regulating the insurance benefit was to address market failure stemming from adverse selection. The case against parity was based on inefficiency related to moral hazard. Empirical analyses provided evidence that ambulatory mental health services were considerably more responsive to the terms of insurance than were ambulatory medical services.
Aims: Our goal in this research is to reexamine the economics of parity in the light of recent changes in the delivery of health care in the United States. Specifically managed care has fundamentally altered the way in which health services are rationed. Benefit design is now only one mechanism among many that are used to allocate health care resources and control costs. We examine the implication of these changes for policies aimed at achieving parity in insurance coverage.
Method: We develop a theoretical approach to characterizing rationing under managed care. We then analyze the traditional efficiency concerns in insurance, adverse selection and moral hazard in the context of policy aimed at regulating health and mental health benefits under private insurance.
Pub Date : 1999-01-29DOI: 10.1002/(SICI)1099-176X(199812)1:4<209::AID-MHP26>3.0.CO;2-C
William S. Cartwright
{"title":"J. Mental Health Policy Econ. 1: 209 (1998). Cost-Outcome Methods for Mental Health. By William A. Hargreaves, Martha Shumaway, The-wei Hu, and Brian Cuffel. San Diego: Academic Press, 1998","authors":"William S. Cartwright","doi":"10.1002/(SICI)1099-176X(199812)1:4<209::AID-MHP26>3.0.CO;2-C","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199812)1:4<209::AID-MHP26>3.0.CO;2-C","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 4","pages":"209"},"PeriodicalIF":1.6,"publicationDate":"1999-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199812)1:4<209::AID-MHP26>3.0.CO;2-C","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71986002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1999-01-29DOI: 10.1002/(SICI)1099-176X(199812)1:4<161::AID-MHP21>3.0.CO;2-I
Michael T. French, Gary A. Zarkin
<p><b>Background</b>: A few recent studies have examined the relationship between mental illness and labor market variables. The findings are inconsistent, however, and leave unanswered many questions concerning both the nature and magnitude of the relationship.</p><p><b>Aims of the Study</b>: A recently available worksite-based data set is analyzed to explore the relationship between symptoms of emotional and psychological problems and employee absenteeism and earnings among employees at a large US worksite.</p><p><b>Methods</b>: The analysis was based on data collected through a random and anonymous survey of workers at a large US manufacturing worksite. Two measures of absenteeism are combined—days absent during the past 30 days due to sickness or injury and days absent during the past 30 days because the employee did not want to be at work—to create both a dichotomous (i.e., ever absent) and a continuous (i.e., number of days absent) absenteeism variable. Annual earnings were measured as personal earnings from the primary job. Various statistical models were tested to determine the independent and joint (with alcohol and illicit drug use) relationship between symptoms of emotional problems and labor market variables.</p><p> <b>Results</b>: The analysis consistently finds that workers who report symptoms of emotional/psychological problems have higher absenteeism and lower earnings than otherwise similar coworkers. This finding is robust to model specification and to the inclusion of comorbid conditions such as alcohol and illicit drug use.</p><p><b>Discussion</b>: This study contributes new information to the literature in this area by estimating the effects of emotional/psychological symptoms on two important labor market variables: absenteeism and earnings. Several specifications of the absenteeism and earnings equations were estimated to test the independent effect of emotional symptoms and the joint effects of emotional symptoms and other comorbid conditions. The results suggest that employers should consider the productivity losses associated with workers’ mental health when designing worksite-based programs such as employee assistance programs (EAPs).</p><p><b>Limitations</b>: Unlike national surveys of households or individuals, the sample does not include unemployed individuals or those outside the labor force. Therefore, the decision to participate in the labor market can not be modeled. In addition, the study relies on voluntary self-reported survey data that may suffer from underreporting of substance use and emotional symptoms. Although respondents were repeatedly assured about confidentiality, if underreporting does exist, it may be more acute than in household surveys because respondents may be more worried about job loss if they self-report drug or alcohol use at the worksite.</p><p><b>Conclusions</b>: All four measures of emotional symptoms had a positive and statistically significant relationship with absenteeism and a negati
{"title":"Mental health, absenteeism and earnings at a large manufacturing worksite","authors":"Michael T. French, Gary A. Zarkin","doi":"10.1002/(SICI)1099-176X(199812)1:4<161::AID-MHP21>3.0.CO;2-I","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199812)1:4<161::AID-MHP21>3.0.CO;2-I","url":null,"abstract":"<p><b>Background</b>: A few recent studies have examined the relationship between mental illness and labor market variables. The findings are inconsistent, however, and leave unanswered many questions concerning both the nature and magnitude of the relationship.</p><p><b>Aims of the Study</b>: A recently available worksite-based data set is analyzed to explore the relationship between symptoms of emotional and psychological problems and employee absenteeism and earnings among employees at a large US worksite.</p><p><b>Methods</b>: The analysis was based on data collected through a random and anonymous survey of workers at a large US manufacturing worksite. Two measures of absenteeism are combined—days absent during the past 30 days due to sickness or injury and days absent during the past 30 days because the employee did not want to be at work—to create both a dichotomous (i.e., ever absent) and a continuous (i.e., number of days absent) absenteeism variable. Annual earnings were measured as personal earnings from the primary job. Various statistical models were tested to determine the independent and joint (with alcohol and illicit drug use) relationship between symptoms of emotional problems and labor market variables.</p><p> <b>Results</b>: The analysis consistently finds that workers who report symptoms of emotional/psychological problems have higher absenteeism and lower earnings than otherwise similar coworkers. This finding is robust to model specification and to the inclusion of comorbid conditions such as alcohol and illicit drug use.</p><p><b>Discussion</b>: This study contributes new information to the literature in this area by estimating the effects of emotional/psychological symptoms on two important labor market variables: absenteeism and earnings. Several specifications of the absenteeism and earnings equations were estimated to test the independent effect of emotional symptoms and the joint effects of emotional symptoms and other comorbid conditions. The results suggest that employers should consider the productivity losses associated with workers’ mental health when designing worksite-based programs such as employee assistance programs (EAPs).</p><p><b>Limitations</b>: Unlike national surveys of households or individuals, the sample does not include unemployed individuals or those outside the labor force. Therefore, the decision to participate in the labor market can not be modeled. In addition, the study relies on voluntary self-reported survey data that may suffer from underreporting of substance use and emotional symptoms. Although respondents were repeatedly assured about confidentiality, if underreporting does exist, it may be more acute than in household surveys because respondents may be more worried about job loss if they self-report drug or alcohol use at the worksite.</p><p><b>Conclusions</b>: All four measures of emotional symptoms had a positive and statistically significant relationship with absenteeism and a negati","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 4","pages":"161-172"},"PeriodicalIF":1.6,"publicationDate":"1999-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199812)1:4<161::AID-MHP21>3.0.CO;2-I","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71986004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1998-12-04DOI: 10.1002/(SICI)1099-176X(199803)1:1<3::AID-MHP4>3.0.CO;2-Q
Joan R. Bloom PhD, Teh-wei Hu Ph.D, Neal Wallace M.P.A., Brian Cuffel Ph.D., Jackie Hausman M.P.P., M.P.H., Richard Scheffler Ph.D.
<p><b>Background</b>: This study presents preliminary findings for the first nine months of the State of Colorado USA Medicaid capitation Pilot Project. Two different models of capitation (model I and model II) are compared with fee for service (FFS) in providing services to severely and persistently mentally ill adults. In model I the state’s mental health authority contracts with community mental health centers (CMHCs) who both manage the care and deliver mental health services, while in model II the state contracted with a joint venture between a for-profit managed care firm who manage the care with either a single CMHC or an alliance of CMHCs who deliver the mental health services.</p><p><b>Aims</b>: Our objective is to examine utilization, cost and outcomes of inpatient and outpatient (including community based) services before and after the implementation of a capitated payment system for Colorado’s Medicaid mental health services compared to services that remained under FFS reimbursement.</p><p><b>Methods</b>: The stratified, random sample includes 513 consumers (188 for model I, 179 for model II, and 146 for FFS). Consumer outcomes were collected by trained interviewers and include 17 measures of symptoms, health status, functioning, quality of life and consumer satisfaction. Utilization and cost of services are from the Medicaid claims data and a shadow billing data system (post-capitation) designed by Colorado. The first step of the two-step regression procedure adjusts for the presence of individuals with use or no service use during the specified time while the second step, ordinary least-squares regression, is applied to the sample who utilized services.</p><p><b>Results</b>: These preliminary findings indicate consistent reductions in inpatient user costs and probability of outpatient use under capitation. Combining all services, there are consistent reductions in the probability of use in both models: model I had significantly higher initial probability of use for any service. Only model II showed a statistically significant decrease in post-capitation overall user costs, but they were initially higher than model I or FFS. Estimated total cost per person for model I suggests virtually no change from the pre- to post-capitation period. Model II had the highest pre-capitation and the lowest post-capitation estimated cost per person. Examination of pre measures of outcomes across capitated areas suggest that samples drawn from the FFS, model I and model II areas were comparable in severity of psychiatric symptoms, functioning, health status and quality of life. No changes were found in outcomes.</p><p><b>Discussion</b>: These early findings are consistent with the limited literature on capitation. Both studies of capitation integrated with medical care and those specific to mental health settings did not find adverse changes in outcomes compared to FFS. <i>Limitations</i> include the short follow-up period, lack of detail and possible
{"title":"Mental health costs and outcomes under alternative capitation systems in Colorado: early results","authors":"Joan R. Bloom PhD, Teh-wei Hu Ph.D, Neal Wallace M.P.A., Brian Cuffel Ph.D., Jackie Hausman M.P.P., M.P.H., Richard Scheffler Ph.D.","doi":"10.1002/(SICI)1099-176X(199803)1:1<3::AID-MHP4>3.0.CO;2-Q","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199803)1:1<3::AID-MHP4>3.0.CO;2-Q","url":null,"abstract":"<p><b>Background</b>: This study presents preliminary findings for the first nine months of the State of Colorado USA Medicaid capitation Pilot Project. Two different models of capitation (model I and model II) are compared with fee for service (FFS) in providing services to severely and persistently mentally ill adults. In model I the state’s mental health authority contracts with community mental health centers (CMHCs) who both manage the care and deliver mental health services, while in model II the state contracted with a joint venture between a for-profit managed care firm who manage the care with either a single CMHC or an alliance of CMHCs who deliver the mental health services.</p><p><b>Aims</b>: Our objective is to examine utilization, cost and outcomes of inpatient and outpatient (including community based) services before and after the implementation of a capitated payment system for Colorado’s Medicaid mental health services compared to services that remained under FFS reimbursement.</p><p><b>Methods</b>: The stratified, random sample includes 513 consumers (188 for model I, 179 for model II, and 146 for FFS). Consumer outcomes were collected by trained interviewers and include 17 measures of symptoms, health status, functioning, quality of life and consumer satisfaction. Utilization and cost of services are from the Medicaid claims data and a shadow billing data system (post-capitation) designed by Colorado. The first step of the two-step regression procedure adjusts for the presence of individuals with use or no service use during the specified time while the second step, ordinary least-squares regression, is applied to the sample who utilized services.</p><p><b>Results</b>: These preliminary findings indicate consistent reductions in inpatient user costs and probability of outpatient use under capitation. Combining all services, there are consistent reductions in the probability of use in both models: model I had significantly higher initial probability of use for any service. Only model II showed a statistically significant decrease in post-capitation overall user costs, but they were initially higher than model I or FFS. Estimated total cost per person for model I suggests virtually no change from the pre- to post-capitation period. Model II had the highest pre-capitation and the lowest post-capitation estimated cost per person. Examination of pre measures of outcomes across capitated areas suggest that samples drawn from the FFS, model I and model II areas were comparable in severity of psychiatric symptoms, functioning, health status and quality of life. No changes were found in outcomes.</p><p><b>Discussion</b>: These early findings are consistent with the limited literature on capitation. Both studies of capitation integrated with medical care and those specific to mental health settings did not find adverse changes in outcomes compared to FFS. <i>Limitations</i> include the short follow-up period, lack of detail and possible","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 1","pages":"3-13"},"PeriodicalIF":1.6,"publicationDate":"1998-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199803)1:1<3::AID-MHP4>3.0.CO;2-Q","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72137499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：