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Example research essay topic: Managed Care In The Psychiatric Setting - 1,646 words

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Managed Care in the Psychiatric Setting The healthcare has been of the greatest interest to governments around the world throughout the human history. The age dynamics, death expectations, and fertility rates are the facts that matter when the government ponders some social program. I should note here that if the US government managed to provide the health care to every US citizen, it would probably be re-elected billion times, because health issues, government support and aid can be used as a competitive leverage against the political rivals. Managed care organizations have been existing since the 1920 s. Important growth and national attention came during the mid 1970 s when Congress approved the Health Maintenance Organization (HMO) Act. This section of legislation made low cost loans accessible to organizations willing to create HMOs.

The law also made available that an HMO could require an employer to offer its plan as an alternative to its traditional indemnity health insurance. It was through this time that a new type of HMO, the Independent Physician Association (IPA) model, started to expand. This type of HMO develops from the staff model by hiring established classified practicing physicians to join the HMO network. The relationship between the HMO and the physician is contract-based and non-exclusive, unlike the staff model. In the 1960 s and the 1970 s, health care costs started to rise at a much faster rate than the Gross National Product (GNP). This rise translated to year-to-year raises in health insurance premiums.

The increase was borne by two groups: employers and the federal government. It was during this time that HMOs began to persuade more employers to offer their plans. Government employers were fast to provide the HMO option. Over the years, more employers and their employees joined managed care plans as the enrollees became more and more familiar with the way managed care plans in a psychiatric setting worked. They became more satisfied with the quality of health care and were happy to evade out-of-pocket expenses, resulting in steady growth. (Appelbaum, 1998) As a response to the increasing costs and utilization of psychiatric services of inpatient services, tight control has become part of all managed care plans. Concern was expressed in the 1980 s that hospital beds were being over utilized for psychiatric patients.

Psychiatric admissions for adolescents increased three and a half times between 1980 and 1984. The number of beds devoted to chemical dependency doubled during the early 1980 s. The number of private psychiatric hospitals and the number of hospital beds devoted to this type of treatment also increased substantially. With major corporations spending between 15 and 25 percent of their total health benefits on psychiatric and substance abuse treatment, it is not surprising that there is concern. Part of the problem stems from partial efforts to contain costs, thereby working, like a balloon being squeezed, to push demand in new directions.

Another part of the problem comes from increased monetization in this field. In health care, providers can create their own markets and surpluses by working around the regulatory controls. When Yale School of Management and Organization professor John Thompson developed the 470 Diagnostic Related Groups and introduced them to control Medicare expenditures for hospital stays, no effort was made to include mental illness in the length of stay averages created. Moreover, the prospective payment system was accompanied by another needed congressional correction in the payment system to eliminate lavish depreciation benefits as a tax advantage to the for-profit investors.

The new accounting law reduced the profitability of community hospitals. Hence capital shifted from acute-care hospitals to private psychiatric facilities and freestanding high-technology diagnostic centers. Nonprofits established psychiatric beds to capture the well-insured patient, an increasingly scarce prize. To understand managed care, it is helpful to have an understanding of traditional compensation insurance. The insurer indemnifies the member against financial losses due to the cost of treating a disease or a medical condition. To keep the costs of health plans competitive, managed care organizations also have set limits on hospital stays for drug abuse, alcohol abuse, and psychiatric care.

The movement to contain costs makes these kinds of care less available. It should be noted that the cutbacks on these benefits in indemnity policies preceded the shift to managed care. (Birenbaum, 1999) The insurer reimburses the insured based on the amount of the medical cost. In the indemnity system, there is no incentive for the health care provider to withhold or limit the number of hospital stays, procedures, etc. This results in increased utilization or medical services, with a higher cost. Therefore, the indemnity plans must increase their premiums in an attempt to catch up with their financial losses. (Rodwin, 1998) A key component of managed cares in a psychiatric setting payments to health providers is the concept of concurrent payment in exchange for concurrent care.

Instead of paying providers based on the amount of care provided to patients, the managed care organizations would pay the medical groups for their assumption of the risks of care. In this type of system, the provider receives a fixed portion of the health insurance premium in exchange for an agreement to provide care to the health plan's members. This fee is normally based on the number of health plan members assigned to the provider. Since it is based on a "headcount" of the enrolled membership, the payment has been called capitation.

In this system, there is no financial incentive to provide more care since the monthly payment is a fixed amount regardless of the actual services provided. In this manner, the managed care organizations are able to fix their medical loss expenses. By being able to fix its medical loss expenses, the managed care plan that capitate's its providers is able to contain costs and remain profitable. This also translates to competitive premiums and, most recently, even reductions in premiums for employer groups, which contribute to the future growth of managed care membership. (Rodwin, 1998) Naturally, psychiatrists have analyzed managed care from a psychodynamic perspective. What they have presented is a classic case of sociological ambivalence when they cannot follow through on a treatment plan that they believe is beneficial for a patient. In essence, they assessed the clinical impact of managed care review.

If doctors take an oath to do no harm, then perhaps managed care companies, built around the use of medical expertise, need to be sworn in as well. Ever vigilant, managed care reviewers created uncertainty for the already vulnerable patient who was making progress - but seldom in a straight line. Following an analysis of the borderline personality, these clinicians suggest through detailed case material that there are serious consequences for patients who have difficulty processing this information. Moreover, treatment team members have difficulties working with a patient when they know that treatment time is limited.

Families of patients are impacted upon as well when the reviewer gives a different view of the need for treatment. In sum, expectations of closing opportunities can create a sense of panic. How widespread are these experiences? Recent surveys found that more than three-fourths of the psychiatrists who responded had experienced pressure from the insurance companies to discharge patients early. In addition, nearly two-thirds reported that hospitals limited lengths of stay, and half were discouraged from treating severely ill uninsured patients or Medicaid recipients. As an example, a patient admitted to the psychiatric unit of a hospital after a suicide attempt was initially denied authorization for continued stay. (Neuman, Ptak, 2003) Managed care in psychiatric treatment did not stem only from rising costs.

Special concern is raised because primary care physicians who are at risk financially may face disincentives to refer their chronically ill patients to specialists, to rehabilitation, or to extended psychiatric care or the like. (Freund, Lewit, 1993) There has always been some bias in medicine against psychiatry, but even medical doctors know that real diseases affect mental states and make people dangerous to themselves or others or create real suffering in people who cannot fully take care of themselves. Moreover, the families of people suffering from psychoses or schizophrenia deserve intervention and relief from their burden. Despite this finding, there is still a need for basic routine care in the area of mental as well as physical disease. Insurance in general does not encourage early detection and intervention through benefits for seeing a regular source of primary care, and it is not so different when it comes to access to a psychiatrist, psychologist, or social worker. There is a need to demonstrate the cost-offset advantages of early intervention.

Psychiatry and other mental health services are particularly vulnerable to managed care concepts. For managed care in a psychiatric setting to grow, there must be certain market conditions. If any of these factors exist, there is a likelihood of some managed care presence. When multiple conditions exist, the likelihood of significant managed care penetration is increased. Bibliography: Appelbaum, Paul S. Legal Liability and Managed Care History.

American Psychologist, March 1998. Feldman, S. Managed mental health services. Springfield, IL, 1999. Rodwin, Marc A. Conflicts in managed care.

The New England Journal of Medicine, v. 332, 1998. Disability and Managed Care: Problems and Opportunities at the End of the Century Book by Arnold Birenbaum; Praeger, 1999. Freund D. A.

and Lewit E. M. Managed care for children and pregnant women: Promises and pitfalls. The Future of Children 3, 1993.

Journal article by Paula R. Danzinger, Elizabeth Reynolds Well; The Impact of Managed Care on Mental Health Counselors: A Survey of Perceptions, Practices, and Compliance with Ethical Standards Journal of Mental Health Counseling, Vol. 23, 2001. Journal article by Karen M. Neuman, Margaret Ptak; Social Work, Managing Managed Care through Accreditation Standards Vol. 48, 2003. Journal article by Jeffrey A.

Cohen; Social Work, Managed Care and the Evolving Role of the Clinical Social Worker in Mental Health Vol. 48, 2003.


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Research essay sample on Managed Care In The Psychiatric Setting

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