Psychiatric Services and Medical Utilization in a Prepaid Health Plan Setting: Part II

O’Donohue

J Clin Psychol Med Settings

2009

Self Cite

There are two reasons why mental health, now more appropriately termed behavioral healthcare, is declining: (a) a lack of understanding among psychotherapists of healthcare economics, particularly the intricacies of medical cost offset, and (b) our failure as a profession to see the importance of behavioral interventions as an integral part of the healthcare system inasmuch as the nation pays for healthcare, not psychosocial care. This paper will briefly describe the rapid changes in the economics of healthcare during the past 75 years, including the post World War II enthusiastic espousal of psychotherapy by the American public which was followed by a precipitous decline as our outcomes research in behavioral care remained ignorant of financial outcomes, leaving it to the government and managed care to arbitrarily curtail escalating mental health costs. At the present time psychology is on the cusp of becoming part of the healthcare system through integrated behavioral/primary care, renewing the primacy of financial considerations such as return on investment (ROI) and medical cost offset, as well as an urgency that we avoid the mistakes that are emerging in some flawed implementations of integrated care.Keywords Healthcare economics Á Medical cost offset Á Integrated behavioral/primary care Very few people do anything creative after the age of 35. The reason is that very few people do anything creative before the age of 35.

Section: Integration Not Just Collaborationmentioning

confidence: 99%

The Financial Dimension of Integrated Behavioral/Primary Care

O’Donohue

J Clin Psychol Med Settings

2009

Self Cite

Journal of Health and Social Behavior

“…While there is considerable research supporting the hypothesis that psychologically distressed persons disproportionately use medical services (Cooper, 1964;Kellner, 1963;Cummings and Follette, 1968;Shepherd et al, 1966;Mechanic and Volkart, 1961;Roghmann and Haggerty, 1975), these studies tend to have a variety of limitations in documenting convincingly the impact of distress relative to other dispositional, attitudinal, or illness factors. Most of these studies have been retrospective rather than prospective (for exceptions, see Shepherd et al, 1966;Roghmann and Haggerty, 1975) of psychological distress with measures of utilization, and no study has examined the influence of distress in conjunction with a wide variety of other variables describing personal inclinations and illness.…”

mentioning

confidence: 99%

The Effect of Psychological Distress on Physician Utilization: A Prospective Study

Tessler¹,

Mechanic²,

Dimond³

1976

215

International Review of Psychiatry

“…Patients with high levels of MUS have disproportionately elevated rates of medical care utilization (Cummings & Follette, 1968;Hilkevitch, 1965), including outpatient visits (deGruy et al, 1987), hospitalizations (Barsky et al, 1991;Fink, 1992;Zoccolillo & Cloninger, 1986), and total health care costs (Craig et al, 1993;deGruy et al, 1987;Smith et al, 1986). This excessive utilization is particularly maladaptive and suboptimal because these patients tend to ' doctor shop ' , have higher rates of emergency visits, and are non-compliant with scheduled appointments (Beaber & Rodney, 1984;Escobar et al, 1987;Simon, 1992;Smith et al, 1986).…”

Section: Why Bother So Much About Medically Unexplained Symptoms In Tmentioning

confidence: 99%

Somatic symptoms in consultation-liaison psychiatry

Grover

Kate

2013

In medically ill patients the term 'somatic symptoms' is used to understand those symptoms which cannot be fully understood in the light of existing medical illness(es). These include a number of physical symptoms and also certain clinical syndromes such as irritable bowel syndrome, fibromyalgia, and chronic fatigue syndrome among others. However, it is increasingly recognized that such patients have larger degrees of psychological morbidities, especially depressive and anxiety disorders, and have disproportionately elevated rates of medical care utilization, including outpatient visits, hospitalizations and total healthcare costs. In view of this psychological morbidity, significant distress and functional impairment, the role of the consultation-liaison psychiatrist is prominent in the management of these patients. A consultation-liaison (CL) psychiatrist is expected to be part of the primary care team to manage patient with unexplained SS, and at the same time is expected to guide colleagues to practice a patient-centred approach to improve the outcome of patients with such symptoms. The clinical work of a CL psychiatrist involves evaluation of patients with medically unexplained symptoms for probable psychiatric disorders and treatment of psychiatric morbidity and also management of patients without psychiatric morbidity. Management strategies include reattribution, cognitive behaviour therapy and antidepressants, with each strategy showing varying degrees of success.