ABSTRACT
The overall complexity and systemic impact of what is ostensibly a simple change in payment methods were the most important lessons to learn.
Subject(s)
Capitation Fee , Mental Health Services/economics , Risk Sharing, Financial , State Health Plans/economics , Adult , Child , Humans , Mental Health Services/organization & administration , Oregon , State Health Plans/organization & administration , United StatesABSTRACT
This paper addresses a variety of issues related to risk in a child and family service system of care that uses managed care techniques. A strong emphasis is placed on sharing rather than shifting risk. How to optimize or balance competing interests is still an imprecise art, but most would agree that successful implementation of a comprehensive service system for children and families will depend in large part on identifying potentially competing interests and realigning them so that all parties share the same interests. Too much risk can paralyze; too little risk can limit creativity, resourcefulness, and industry.
Subject(s)
Capitation Fee , Child Health Services/economics , Insurance Pools , Managed Care Programs/economics , Child , Child Health Services/organization & administration , Community Participation , Cost Control , Humans , Managed Care Programs/organization & administration , Managed Care Programs/statistics & numerical data , Risk Management , United StatesABSTRACT
Funding reductions and changes in the priorities of funding agencies have deeply affected community mental health programs. The burden of handling resource scarcity and shifting service priorities falls primarily on the community boards and staff of local agencies. We report a Delphi study in which an expert panel of 106 community mental health center executive directors and government officials generated a list of key strategies that local agencies could take to survive cutbacks. From an initial list suggested by the panel, a consensus was developed on the 15 most important and most feasible strategies. Discussion focuses on the implications and use of these strategies to promote the survival, even growth, of community-based mental health services during times of scarcity.
Subject(s)
Community Mental Health Services/economics , Mental Disorders/therapy , Cost Control , Delivery of Health Care/economics , Financing, Government/economics , Humans , United StatesABSTRACT
Planning is a management activity that has been linked to high quality services, organizational growth, and in austere times, to organizational survival. The present study was undertaken to identify the critical barriers that inhibit or derail effective planning. It was predicted that human service and corporate managers would generally agree about the most and least important planning pitfalls in their systems. Discrepancies would be related to differences in the structural characteristics of organizations in the two sectors. Rankings made by 57 senior mental health administrators of the most and least important pitfalls in planning were contrasted with those of 159 corporate executives. Substantial agreement between the two groups of executives was found.
