TY - JOUR
KW - Antipsychotic Agents/economics/therapeutic use
KW - Cost Control/legislation & jurisprudence
KW - Diagnostic Errors
KW - Drug Utilization/economics/statistics & numerical data
KW - Health Care Costs/trends
KW - Health Maintenance Organizations/economics/legislation & jurisprudence/standards
KW - Health Services Accessibility/legislation & jurisprudence
KW - Humans
KW - Mental Disorders/diagnosis/drug therapy/economics
KW - Mental Health Services/economics/standards/supply & distribution
KW - Outcome and Process Assessment (Health Care)
KW - Physician's Practice Patterns/economics/statistics & numerical data
KW - Primary Health Care/economics
KW - Psychiatry/economics
KW - Randomized Controlled Trials as Topic
KW - Referral and Consultation/economics/utilization
KW - United States
AU - S. D. Horn
A1 - 
AB - Restricted access to health care services and medication is associated with overall higher utilization and higher health care costs. Although randomized controlled trials (RCTs) are regarded as the best method of determining whether a treatment strategy does more good than harm, clinical practice improvement (CPI) methods may be a more effective way of achieving superior medical outcomes for the least cost over the course of a patient's care. The Managed Care Outcomes Project, a large-scale CPI study, tracked detailed factors regarding medical care, patients, and outcomes from different managed care settings. Results showed that cost-containment strategies employed by various health maintenance organizations were associated with poor treatment outcomes for patients and in fact increased total health care costs. Psychiatric illnesses were underdiagnosed, and care ranged from patients receiving psychiatric medications without a psychiatric diagnosis to patients with a psychiatric diagnosis receiving no psychiatric treatment at all. Cost-containment strategies appeared to limit psychiatric referrals, frequency of psychiatric visits, and use of certain antidepressants (i.e., selective serotonin reuptake inhibitors). Further, the severity of the primary physical illness in the study population was associated with greater psychiatric illness. The fact that treatment was inconsistent and frequently inappropriate shows the need for better diagnostic and management protocols.
BT - The Journal of clinical psychiatry
C5 - Financing & Sustainability
CY - United States
JF - The Journal of clinical psychiatry
N2 - Restricted access to health care services and medication is associated with overall higher utilization and higher health care costs. Although randomized controlled trials (RCTs) are regarded as the best method of determining whether a treatment strategy does more good than harm, clinical practice improvement (CPI) methods may be a more effective way of achieving superior medical outcomes for the least cost over the course of a patient's care. The Managed Care Outcomes Project, a large-scale CPI study, tracked detailed factors regarding medical care, patients, and outcomes from different managed care settings. Results showed that cost-containment strategies employed by various health maintenance organizations were associated with poor treatment outcomes for patients and in fact increased total health care costs. Psychiatric illnesses were underdiagnosed, and care ranged from patients receiving psychiatric medications without a psychiatric diagnosis to patients with a psychiatric diagnosis receiving no psychiatric treatment at all. Cost-containment strategies appeared to limit psychiatric referrals, frequency of psychiatric visits, and use of certain antidepressants (i.e., selective serotonin reuptake inhibitors). Further, the severity of the primary physical illness in the study population was associated with greater psychiatric illness. The fact that treatment was inconsistent and frequently inappropriate shows the need for better diagnostic and management protocols.
PP - United States
PY - 2003
SN - 0160-6689; 0160-6689
SP - 23
EP - 28
EP - 
T1 - Limiting access to psychiatric services can increase total health care costs
T2 - The Journal of clinical psychiatry
TI - Limiting access to psychiatric services can increase total health care costs
U1 - Financing & Sustainability
U2 - 14680424
VL - 64 Suppl 17
VO - 0160-6689; 0160-6689
Y1 - 2003
ER -