Journal of Mental Health Policy and Economics最新文献

{"title":"Labor market conditions and employment of the mentally ill","authors":"Ralph Catalano,&nbsp;Robert E. Drake,&nbsp;Deborah R. Becker,&nbsp;Robin E. Clark","doi":"10.1002/(SICI)1099-176X(199906)2:2<51::AID-MHP44>3.0.CO;2-%23","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199906)2:2<51::AID-MHP44>3.0.CO;2-%23","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The mental health services literature includes assertions that workers with mental illness are at earlier risk of unemployment than other workers when the economy contracts. This possibility is important for several reasons. One is that such a phenomenon would support the argument that the lives of mentally ill persons are made unnecessarily stressful by the stigma of mental illness. Another is that the phenomenon could distort comparisons of the effectiveness of programs designed to prepare persons with severe mental illness for work. Despite its importance, the assertion that severely mentally ill workers are at early risk of unemployment has never been empirically tested.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims of the Study</h3>\u0000 \u0000 <p>We aim to test the hypothesis that unemployment among persons with severe mental illness (SMI) increases before job loss among other workers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We test the hypothesis by applying Granger causality methods to time-series data collected in two communities in the United States (i.e., Concord and Manchester, NH) over 131 weeks beginning on 12 May 1991.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We find no relationship between job loss in the labor market and the likelihood that persons with SMI will be unemployed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>We speculate that persons with SMI participate in the secondary labor market and that their employment status is unlikely to be well described by data gathered in the primary labor market. This implies that widely available measures of labor market status, which are designed to describe the primary labor market, cannot be used to improve the evaluation of programs intended to prepare the mentally ill for work. We also discuss the possibility that persons with SMI may have needs that are better met by the secondary than by the primary labor market.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The intuition that workers with severe mental illness are affected earlier than other workers by labor market contraction may not be correct. We infer that persons with severe mental illness may participate in the secondary labor market about which we know relatively little. We cannot, therefore, easily adjust program evaluations to disentangle intervention effects from those, if any, of the labor market. Copyright © 1999 John Wiley &amp; Sons, Ltd.</p>\u0000 </section>\u0000 </div>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 2","pages":"51-54"},"PeriodicalIF":1.6,"publicationDate":"1999-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71952120","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":"Information needs for community practice: responding to the challenge","authors":"Grayson S. Norquist","doi":"10.1002/(SICI)1099-176X(199906)2:2<87::AID-MHP45>3.0.CO;2-I","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199906)2:2<87::AID-MHP45>3.0.CO;2-I","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 2","pages":"87-89"},"PeriodicalIF":1.6,"publicationDate":"1999-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199906)2:2<87::AID-MHP45>3.0.CO;2-I","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71952750","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":"Managed behavioral health care and supply-side economics. 1998 Carl Taube Lecture","authors":"Richard M. Scheffler","doi":"10.1002/(SICI)1099-176X(199903)2:1<21::AID-MHP33>3.0.CO;2-O","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199903)2:1<21::AID-MHP33>3.0.CO;2-O","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Within the past decade, the mental health care system in the United States has undergone a significant transformation in terms of delivery, financing and work force configuration. Contracting between managed care organizations (MCOs) and providers has become increasingly prevalent, paralleling the trend in health care in general. These managed care carve-outs in behavioral health depend on networks of providers who agree to capitated rates or discounted fees for service for those patients covered by the carve-out contracts. Moreover, the carve-outs use a broader array of mental health providers than is typically found in traditional indemnity plans, encourage time-limited versus long-term treatments and favor providers who are engaged in outpatient care.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;This phenomenal growth in managed behavioral health care over the past decade includes the rapid growth and quick consolidation of mental health MCOs. The period 1992–1998 shows steady and substantial annual increases in the number of enrollees in mental health MCOs, the figure more than doubling from 78.1 million people in 1992 to a projected 156.6 million in 1998, or 70% of insured lives. Moreover, these vast numbers of enrollees are becoming increasingly consolidated into a smaller number of firms. In 1997, 12 companies controlled nearly 85% of the managed behavioral health care market, with 60% of the market held by the three largest firms.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Study Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This article reviews empirical data and draws policy implications from the literature on managed behavioral health care in the United States. Starting with spending and spending trend estimates that show the average annual growth rate of mental health expenditures to be lower than that of health care expenditures in general over the past decade, the author examines utilization and price factors that may account for managed-care-induced cost reductions in behavioral health care, with special attention to hospital use patterns, fee discounting and the supply and earnings patterns of various types of mental health provider. In addition, data on staffing ratios and provider mixes of health maintenance organizations and mental health MCOs are reviewed as they reveal at least part of the dynamics of reconfiguration of the mental health work force in this era of managed care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;As measured by changes in utilization and price, widespread application of ‘classic’ managed care techniques such as preadmission review (gatekeeping), concurrent review, case management, standardized clinical guidelines and protocols, volume purchase of services and fee discou","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 1","pages":"21-28"},"PeriodicalIF":1.6,"publicationDate":"1999-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199903)2:1<21::AID-MHP33>3.0.CO;2-O","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71945573","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":"Incorporating economic analysis in evidence-based guidelines for mental health: the profile approach","authors":"James Mason,&nbsp;Martin Eccles,&nbsp;Nick Freemantle,&nbsp;Michael Drummond","doi":"10.1002/(SICI)1099-176X(199903)2:1<13::AID-MHP34>3.0.CO;2-M","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199903)2:1<13::AID-MHP34>3.0.CO;2-M","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Many western health systems are currently developing the role of clinical guidelines to promote effective and efficient health care. However, introducing economic data into guideline methodology designed to assess the effectiveness of interventions raises some methodological issues. These include providing valid and generalizable cost estimates, the weight placed upon cost ‘evidence’ and presenting cost-effectiveness information in a way that is helpful to clinicians.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim of the Study&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To explore a framework for including economic concepts in the development of a series of primary care guidelines, two of which address mental health conditions.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A profile approach, setting out best available evidence about the attributes of treatment choices (effectiveness, tolerability, safety, health service delivery, quality of life, resource use and cost), was used to help clinicians to derive treatment recommendations in a manner consistent with both the clinical decision-making process and social objectives.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Clinicians involved in guideline development responded well to the process. Although there was often considerable debate about the meaning and importance of different aspects of evidence about treatment, in none of the guideline groups was there failure to agree treatment recommendations.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The profile approach may be particularly useful in the field of mental health where disease processes may often feature very disparate effects, over long periods of time and impacting upon a broad circle of relatives, carers and agencies in addition to the patients themselves.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A method has been applied in a series of primary care guidelines, which appears to enable clinicians to consider the issue of resource use alongside the various clinical attributes associated with treatment decisions. The basis of this work is the belief that guidance presenting physical measures describing effectiveness, adverse events, safety, compliance and quality of life, alongside resource consequences, is most likely to appropriately inform doctor–patient interactions.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Implications for Health Care Provision and Use&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This research","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 1","pages":"13-19"},"PeriodicalIF":1.6,"publicationDate":"1999-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199903)2:1<13::AID-MHP34>3.0.CO;2-M","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71943113","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":"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":"William S. 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":"2 1","pages":"43"},"PeriodicalIF":1.6,"publicationDate":"1999-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199903)2:1<43::AID-MHP36>3.0.CO;2-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71953146","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":"Providing services to families of persons with schizophrenia: present and future","authors":"Lisa Dixon","doi":"10.1002/(SICI)1099-176X(199903)2:1<3::AID-MHP31>3.0.CO;2-0","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199903)2:1<3::AID-MHP31>3.0.CO;2-0","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The important role of families and other caregivers in the lives of adults with schizophrenia is well documented. Persons with schizophrenia frequently live with their families of origin, and the vast majority have regular family contact. Families of persons with schizophrenia have also been demonstrated to have significant needs. Families most frequently cite the need for education and support in helping them to cope with their family member’s illness. Further, numerous studies have documented the benefits of interventions designed to meet the needs of family members.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims of the Study&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This paper identifies critical issues and challenges in the provision of services to families of persons with schizophrenia and other serious and persistent mental illnesses.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study draws from both a literature review and a summary of pertinent data from the Schizophrenia Patient Outcomes Research Team (PORT).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Recent best practices standards and treatment recommendations specify that families should be given education and support. One of the PORT treatment recommendations states that ‘Patients who have on-going contact with their families should be offered a family psychosocial intervention which spans at least nine months and which provides combinations of: Education about the illness; Family support; Crisis intervention; and, Problem solving skills training’. The PORT treatment recommendations are based on well designed and rigorous research on family psychoeducation programs that demonstrate reduced relapse rates and improved patient and family well-being for persons whose families receive psychoeducation. While family psychoeducation programs have been the subject of extensive treatment trials, family members and family organizations have endorsed a variety of other models of services such as family education and consultation models. These models have not been as rigorously researched as family psychoeducation. Control groups are generally lacking. No consistent findings have been reported, although isolated studies have found increased knowledge, self-efficacy and greater satisfaction with treatment among families who have participated in family education programs. Remarkably little is known about the extent to which families actually receive appropriate services. However, PORT data from administrative claims and client interviews suggest that family services are minimal. Further, previous research has consistently revealed that families have high levels of dissa","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 1","pages":"3-8"},"PeriodicalIF":1.6,"publicationDate":"1999-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199903)2:1<3::AID-MHP31>3.0.CO;2-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71945572","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":"Abstracts translations","authors":"Dr Ella Rytik","doi":"10.1002/(SICI)1099-176X(199903)2:1<46::AID-MHP39>3.0.CO;2-W","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199903)2:1<46::AID-MHP39>3.0.CO;2-W","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":"2 1","pages":"46-48"},"PeriodicalIF":1.6,"publicationDate":"1999-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199903)2:1<46::AID-MHP39>3.0.CO;2-W","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71953145","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":"State-of-the-art challenges for mental health services research","authors":"Susan M. Essock","doi":"10.1002/(SICI)1099-176X(199903)2:1<9::AID-MHP32>3.0.CO;2-S","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199903)2:1<9::AID-MHP32>3.0.CO;2-S","url":null,"abstract":"<div>\u0000 \u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Research-based, state-of-the-art services for people with serious mental disorders would consist of demonstrably effective treatments, organized synergistically, and financed in ways that create incentives to provide such treatment. While research exists in these domains of treatment, organization and financing, this research base contains significant gaps, and what is known frequently neither informs policy making nor enters practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Review</h3>\u0000 \u0000 <p>The NIMH services-research portfolio has identified successful patient-level and system-level interventions for people with serious mental disorders, but much of this research has yet to make its way into practice. Similarly, while we have made progress in asking ‘what is good care?’, we have much less information about the answers to ‘what constitutes an adequate try?’. Writing a prescription for an efficacious medication does not constitute an adequate trial of that medication. Similarly, offering people boring psychosocial rehabilitation programs does not constitute an adequate try of promoting recovery via rehabilitation services, but what does? Defining what constitutes an adequate try can be a way of allocating scarce resources or it can be a polite way of defining when a system gets to give up on someone. As state governments move to contract with managed care entities for services for Medicaid beneficiaries, one of the great contracting challenges is defining and monitoring the provision of what constitutes an adequate try.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>To obtain better value for our health care expenditures, we need to find ways to get what we know works into practice, whether we are contracting for services or deciding which clinical therapies to pursue. For example, problem-oriented family therapy has been shown to improve clinical outcomes for people with schizophrenia, yet such interventions are rare in practice. We also need to pay more attention to the quality of the clinical care actually being delivered—not what was prescribed, nor what the clinician was trained in, nor what the job description was, but what actually is occurring. Figuring out how to contract for and disseminate efficacious treatments so that they occur and are effective in real-world settings is critically important yet is a largely unexplored area of services research. We need to answer both ‘what is good care?’ and ‘how do we get it to happen?’. Copyright © 1999 John Wiley &amp; Sons, Ltd.</p>\u0000 </section>\u0000 </div>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 1","pages":"9-12"},"PeriodicalIF":1.6,"publicationDate":"1999-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199903)2:1<9::AID-MHP32>3.0.CO;2-S","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71953148","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":"Economic aspects of mental health carve-outs","authors":"Ingo Vogelsang","doi":"10.1002/(SICI)1099-176X(199903)2:1<29::AID-MHP35>3.0.CO;2-A","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199903)2:1<29::AID-MHP35>3.0.CO;2-A","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Recent empirical research has found behavioral health carve-outs in the US to reduce costs immediately and considerably, compared to indemnity insurance and HMOs. Carve-outs have quickly captured a large part of the organized market in US behavioral health. At the same time, market concentration has increased significantly.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The current paper uses concepts and results from the industrial organization and transaction cost literature to explain (i) why carve-outs hold cost advantages over other institutional arrangements, (ii) why these hold in particular for behavioral health and (iii) why this did not happen earlier.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The main explanatory variables relate to economies of scale, the avoidance of diseconomies of scope, and the avoidance of personal relationships. The sometimes surprising lack of explicit risk-taking by carve-outs and of explicit cost-reducing incentives in carve-out contracts are more than overcome by incentives created from gaining large contracts. The specific advantages of carve-outs in behavioral health derive from a combination of lack of economies of scope with other health services, lack of economies of scale in provision of behavioral health and presence of economies of scale in management. It is conjectured that behavioral health carve-outs have benefited from biomedical innovations that changed the direction of treatments, from computerization that enables large-scale standardized management and from financial pressures on the behavioral health sector.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The empirical basis for the current study is a number of case studies and the rapid penetration of mental health carve-outs in the US. Cost reductions caused by such carve-outs appear to be quite robust. Explaining cost reductions from institutional changes has to start with the question of why the old institution did not implement the same or similar changes. We have emphasized reasons why such changes were not feasible under indemnity insurance and HMOs. Nevertheless, we have not been able to evaluate quality changes that might have accompanied those cost reductions.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Implications for Health Policy&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;While further cost reductions may follow a logistic curve, which simply flattens out, there are developments, regulatory and legal in particular, that could lead to a regression of carve-out costs towards those under other institutional arrangements. Thus, the ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"2 1","pages":"29-41"},"PeriodicalIF":1.6,"publicationDate":"1999-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/(SICI)1099-176X(199903)2:1<29::AID-MHP35>3.0.CO;2-A","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71953147","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":"Cost-effectiveness in Health and Medicine. By M.R. Gold, J.E Siegel, L.B. Russell, and M.C. Weinstein (eds). New York: Oxford University Press, 1996","authors":"D. Shepard","doi":"10.1002/(SICI)1099-176X(199906)2:2<91::AID-MHP46>3.0.CO;2-I","DOIUrl":"https://doi.org/10.1002/(SICI)1099-176X(199906)2:2<91::AID-MHP46>3.0.CO;2-I","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"17 1","pages":"91-92"},"PeriodicalIF":1.6,"publicationDate":"1999-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81566814","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}