The journal of mental health policy and economics
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J Ment Health Policy Econ · Mar 2005
Variation in patient routine costliness in U.S. psychiatric facilities.
The Balanced Budget Refinement Act of 1999 included a Congressional mandate to develop a patient-level case mix prospective payment system (PPS) for all Medicare beneficiaries treated in PPS-exempt psychiatric facilities. Payment levels by case mix category have been proposed by the government based on claims and facility cost reports. Because of claims data limitations, these levels do not account for patient-specific staffing costs within a facility's routine units, nor are certain key patient characteristics considered for higher payment. ⋯ Larger primary samples of special psychiatric units (e.g., med-psych, child/adolescent) could improve estimates of daily routine costliness. Larger samples could also support stronger tests of case mix and cost differences by facility type and teaching status. Medical records information on non-Medicare patients could quantify any systematic differences in average daily costs holding case mix constant. Similar primary studies of psychiatric patients treated outside PPS-exempt units in acute general hospitals could result in a fully integrated payment system for all mentally ill Medicare patients, thereby avoiding payment inefficiencies and inequities.
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J Ment Health Policy Econ · Mar 2005
Implementation of social services for the chronically mentally ill in a Polish mental health district: consequences for service use and costs.
In accordance with the mental health reform in Poland, from 1970 to 1980 the following mental health facilities were established within the general health system in the Warsaw District of Targowek: general hospital psychiatric ward, day hospital, outpatient clinic (OC), and community mobile team (CMT) with some procedures of assertive community treatment (ACT). In 1998 (according to the Mental Health Act of 1994), within the social welfare system, new community facilities were established in this district with psychosocial rehabilitation programs for the chronically mentally ill. These new social welfare facilities were a vocational rehabilitation center (VCR), community center of mutual help (CCOMH), and specialized social help services at client homes (SSHS). ⋯ The activity of the new social welfare facilities (VRC, CCOMH, SSHS) seems to reduce both full time and partial hospitalizations. Despite the increasing costs of medication reimbursement, and the increased use of CMT and OC, the overall costs for the mental health system were substantially reduced. The decrease in day hospital use is probably due to the large amount of daily social support and home services offered in VRC, CCOMH and SSHS. The results emphasize the importance of evaluating the coordination of care for chronically mentally ill patients in the mental health and social welfare systems.
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J Ment Health Policy Econ · Mar 2005
Health status and access to care for children with special health care needs.
About 11-14% of children with special health care needs (CSHCN) have unmet needs during a given year. Little is known about the determinants of unmet health care needs for CSHCN. ⋯ Future research should determine the causal relationship between mental health problems of CSHCN and their caregivers and the level unmet health care needs.