Journal of Mental Health Policy and Economics最新文献

{"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}

{"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}

{"title":"Child outpatient mental health service use: why doesn’t insurance matter?","authors":"Sherry Glied,&nbsp;A. Bowen Garrett,&nbsp;Christina Hoven,&nbsp;Maritza Rubio-Stipec,&nbsp;Darrel Regier,&nbsp;Robert E. Moore,&nbsp;Sherryl Goodman,&nbsp;Ping Wu,&nbsp;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":"&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Aims&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt; Methods&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt; Results&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Discussion&lt;/b&gt;: 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}

{"title":"Parity for mental health and substance abuse care under managed care","authors":"Richard G. Frank,&nbsp;Thomas G. Mcguire","doi":"10.1002/(SICI)1099-176X(199812)1:4<153::AID-MHP20>3.0.CO;2-M","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199812)1:4<153::AID-MHP20>3.0.CO;2-M","url":null,"abstract":"<p><b>Background</b>: 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.</p><p><b>Aims</b>: 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.</p><p><b>Method</b>: 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.</p><p><b>Results</b>: We show that since managed care controls costs and utilization in new ways parity in benefit design no longer implies equal access to and quality of mental health and substance abuse care. Because costs are controlled by management under managed care and not primarily by out of pocket prices paid by consumers, demand response recedes as an efficiency argument against parity. At the same time parity in benefit design may accomplish less with respect to providing a remedy to problems related to adverse selection. © 1998 John Wiley &amp; Sons, Ltd.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 4","pages":"153-159"},"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<153::AID-MHP20>3.0.CO;2-M","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72192541","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}

{"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}

{"title":"Mental health, absenteeism and earnings at a large manufacturing worksite","authors":"Michael T. French,&nbsp;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":"&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Aims of the Study&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt; &lt;b&gt;Results&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Discussion&lt;/b&gt;: 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).&lt;/p&gt;&lt;p&gt;&lt;b&gt;Limitations&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusions&lt;/b&gt;: 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}

{"title":"Mental health costs and outcomes under alternative capitation systems in Colorado: early results","authors":"Joan R. Bloom PhD,&nbsp;Teh-wei Hu Ph.D,&nbsp;Neal Wallace M.P.A.,&nbsp;Brian Cuffel Ph.D.,&nbsp;Jackie Hausman M.P.P., M.P.H.,&nbsp;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":"&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Aims&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results&lt;/b&gt;: 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.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Discussion&lt;/b&gt;: 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. &lt;i&gt;Limitations&lt;/i&gt; 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}

{"title":"Issues in the design of studies for the economic evaluation of new atypical antipsychotics: the ESTO study","authors":"M.F. Drummond,&nbsp;M.R.J. Knapp,&nbsp;T.P. Burns,&nbsp;K.D. Miller,&nbsp;P. Shadwell","doi":"10.1002/(SICI)1099-176X(199803)1:1<15::AID-MHP2>3.0.CO;2-O","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199803)1:1<15::AID-MHP2>3.0.CO;2-O","url":null,"abstract":"&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: Increasing attention is being focused on the costs of healthcare and the need for cost-effective treatments. Drugs for schizophrenia have not escaped this scrutiny, especially now that several new agents are available, with acquisition costs substantially higher than for established therapies. However, most of the existing evaluations of new drugs for schizophrenia have weak designs, either comparing health care costs before and after introduction of the new drug, or being based on modelling approaches incorporating numerous assumptions.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Aim of the Study&lt;/b&gt;: The aim of the study was to discuss and resolve the key design issues in the planning of a prospective randomized trial to assess the socio-economic impact of a new atypical antipsychotic (quetiapine).&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods&lt;/b&gt;: Key methodological issues were identified and discussed in the context of the economic evaluation being planned. These were patient recruitment and entry criteria, selection of comparator drug, blinding of doctor and patient, range of socio-economic outcomes, length of follow-up and sample size.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results&lt;/b&gt;: The resulting economic evaluation, the ESTO study, was an international multi-centre randomized controlled trial, with concurrent data collection for a wide range of clinical, economic and quality of life outcomes. The trial had a pragmatic design, enrolling patients experiencing an acute exacerbation on existing therapy. In addition to the presenting exacerbation, patients must have had at least one hospitalization or documented evidence of exacerbation within the previous three years. On admission to the study, existing psychotic medication was withdrawn prior to randomization to quetiapine or haloperidol. Doses of both drugs were titrated up to an optional dose, with flexibility for additional increases if required.&lt;/p&gt;&lt;p&gt;Both patients and doctors were blinded to treatment allocations, on the grounds that, since quetiapine was still in development, unblinded assessments of efficacy would not be credible. Patients were followed for 1 year, irrespective of whether they withdrew from study medication.&lt;/p&gt;&lt;p&gt;A wide range of socio-economic outcomes was assessed, including costs falling on the healthcare sector, other agencies and the family. In addition data were collected on patients’ earnings and quality of life, measured by the Short-Form 36 health profile. Data were also collected on a range of clinical measures, such as the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI), the AIMS neurological rating scale and the neurological rating scale of Simpson and Angus. This was to assess whether changes in socio-economic end points were indeed matched by changes in the patient’s clinical condition.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusions&lt;/b&gt;: The design of studies such as ESTO is inevitably a compromise between control and pragmatism. For example, whilst blinding of doctor and patient may reduce potential bias, this ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 1","pages":"15-22"},"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<15::AID-MHP2>3.0.CO;2-O","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72137661","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}

{"title":"Physician knowledge, financial incentives and treatment decisions for depression","authors":"Roland Sturm,&nbsp;Kenneth B. Wells","doi":"10.1002/(SICI)1099-176X(199807)1:2<89::AID-MHP12>3.0.CO;2-V","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199807)1:2<89::AID-MHP12>3.0.CO;2-V","url":null,"abstract":"<p><b>Background</b>: Two important policy levers to affect health care delivery are financing and informational interventions. Unfortunately, these two approaches have not been considered simultaneously and little is known about how their effects compare.</p><p><b>Aims of the Study</b>: This paper estimates the relative role of financial incentives (prepaid versus fee for service) and provider information (perceived knowledge of antidepressant medications and skill in counseling for depression) on quality of care for less and more severely depressed patients and their health and cost outcomes.</p><p><b>Methods</b>: We develop a theoretical model of provider behavior and estimate a reduced form using a multinomial probit model with heteroskedastic covariances. The likely effects of changing provider knowledge about depression treatment in primary care are then simulated and contrasted with the effects of a shift toward prepaid managed care as opposed to fee-for-service care. The empirical model is estimated using data from the Medical Outcomes Study.</p><p><b>Results</b>: We conclude that financing and information have different effects and that their combination can achieve the conflicting goals of improved health outcomes and reduced direct treatment goals. Moreover, including family income as one important dimension of social cost suggests that the combination of informational interventions and a shift to prepaid care may dominate either one intervention in isolation from a social cost perspective. Specifically regarding information, we found that increasing provider knowledge could have the highly desirable effect of greater targeting of treatments to sicker patients while not raising overall treatment rates much—a treatment pattern that many hoped managed care could achieve, but for which there has been little evidence.</p><p>Conclusions: Our analysis illustrates the value of considering these widely different policy goals simultaneously. We learned that variation in physician knowledge generally had stronger associations with clinically relevant practice patterns for depression than did a complete change in financing strategy. The moderate change in perceived knowledge we simulated (not near the extremes of observed values of perceived knowledge) was associated with enough improvement in appropriateness of care to more than offset the reduction in appropriateness with a complete shift from fee-for-service to prepaid managed care.</p><p><b>Implications for Health Policy</b>: The paper demonstrates the importance of considering different interventions simultaneously. Combining informational and financial interventions simultaneously can achieve better quality of care and reduce health care costs, something neither intervention can in isolation. © 1998 John Wiley &amp; Sons, Ltd.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 2","pages":"89-100"},"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(199807)1:2<89::AID-MHP12>3.0.CO;2-V","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72137435","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}

{"title":"Factors influencing informal care-giving","authors":"Ann M. Holmes,&nbsp;Partha Deb","doi":"10.1002/(SICI)1099-176X(199807)1:2<77::AID-MHP10>3.0.CO;2-5","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199807)1:2<77::AID-MHP10>3.0.CO;2-5","url":null,"abstract":"BACKGROUND: As downsizing of institutional care continues, patients discharged are likely to have more severe mental illnesses, and to have experienced longer tenures within institutions than patients who have been discharged in the past. As greater numbers of patients are removed from mental hospitals, the objective burden experienced by informal care-givers may increase, particularly if formal care levels are inadequate. AIMS OF THE STUDY: This paper documents who assumes informal care-giver roles, and the form such care-giving takes for patients discharged from a state hospital. Specifically, this paper identifies (i) what factors affect a person's decision to assume a care-giver role, including the participation of other network members in care-giving, (ii) what factors influence whether care-giving is provided in time or in direct purchase of care and (iii) how the patient's treatment location affects the decision of the network member to assume any care-giving role. DATA AND ANALYTICAL METHODS: Data for this paper are taken from a longitudinal study of the closure of a state mental hospital in central Indiana. Seventy-seven patients were asked to identify their community networks. Ninety-eight network members were surveyed about the informal care, both in time or through direct expenditures, they provided to these patients one year after discharge. Care-giving relationships were estimated using a multivariate probit model. Such a model estimates the extent to which the decision to provide care in either form depends on the care-giving activities assumed by other network members associated with a given patient, as well as the characteristics of individual patients and network members. RESULTS: Forty-one per cent of network members provided some level of informal care, with 13.3% providing some care in time, and 35.7% providing some care through direct expenditures. A positive relationship was found between participation in informal care-giving and the perception by the network member that patient needs were not being met by professionals. The decision to provide informal care was also found to be sensitive to the level of informal and formal care received by the patient. Care-giving in expense was found to be positively related to the care-giving decisions of other informal care-givers, but care-giving in time was not. Network members were more likely to provide care in time for patients who had been recently discharged to the community than for patients who remained in institutional settings. CONCLUSIONS: These results suggest the transfer of persons with severe mental illnesses from state hospitals to the community may shift the care burden between formal and informal providers. If this is the case, discharge criteria should include such factors as the community resources available to the patient. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The responsiveness of network members to perceived unmet need bespeaks the importance of informa","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"1 2","pages":"77-87"},"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(199807)1:2<77::AID-MHP10>3.0.CO;2-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72126072","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}