RESUMO
OBJECTIVE: This study examined the prevalence and nature of behavioral health carve-out contracts among Fortune 500 firms in 1997. METHODS: A survey was conducted of 498 companies that were listed as Fortune 500 firms in 1994 or 1995. A total of 336 firms (68 percent) responded to the survey. Univariate analyses were used to analyze prevalence, types, and amounts of covered services, cost sharing, and benefit limits. A total of 132 firms reported contracting with managed behavioral health organizations; 124 firms answered benefits questions about covered services, cost-sharing levels, and annual and lifetime limits. RESULTS: Most of the plans covered a broad range of services. Cost sharing was typically required, and for inpatient care it was often substantial. Fifteen percent of the firms offered mental health benefits that were below the limits defined in this study as minimal benefit levels, and 34 percent offered substance abuse treatment benefits that fell below minimal levels. The most generous mental health benefits and substance abuse treatment benefits, defined as no limits or a lifetime limit only of $1 million or more, were offered by 31 percent and 20 percent of the firms, respectively. CONCLUSIONS: The carve-out contracts of the Fortune 500 firms in this study typically covered a wide range of services, and the benefits appeared generous relative to those reported for other integrated and carve-out plans. However, these benefits generally did not reach the level of parity with typical medical benefits, nor did they fully protect enrollees from the risk of catastrophic expenditures.
Assuntos
Serviços Contratados/estatística & dados numéricos , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Seguro Psiquiátrico/classificação , Programas de Assistência Gerenciada/economia , Serviços de Saúde Mental/economia , Coleta de Dados , Humanos , Indústrias , Benefícios do Seguro , Programas de Assistência Gerenciada/normas , Estados UnidosRESUMO
OBJECTIVE: To determine the prevalence and nature of performance standards in specialty managed behavioral healthcare contracts among Fortune 500 companies. STUDY DESIGN: This was a cross-sectional survey of all companies listed on the Fortune 500 during 1994, 1995, or both. METHODS: From April 1997 to May 1998 we conducted a mailed survey with phone follow-up. Of the 68% of firms that responded, over one third reported carve-out contracts. The survey focused on whether companies had behavioral health carve-out contracts with specialty vendors and characteristics of these contracts, including the use of performance standards. RESULTS: More than three quarters of the Fortune 500 companies reporting specialty behavioral healthcare contracts used at least one performance standard. Most common were administrative standards (70.2%) and customer service standards (69.4%). About half of the companies used quality standards, whereas only a third used provider-related standards. Most (58.8%) companies using performance standards also specified financial consequences. Larger Fortune 500 firms were significantly more likely to use performance standards. Risk contracts and contracts that included all covered employees were also more likely to include some categories of standards. CONCLUSIONS: Administrative and customer service standards may be most common because companies find it easier to specify those standards, especially compared with clinical quality measures. To the extent that employers want to obtain the most value from their behavioral healthcare purchasing, we expect that more will begin to adopt quality standards in their contracts, especially as performance measures become more refined. Reliance on accreditation, however, is an alternative approach for employers.
Assuntos
Planos de Assistência de Saúde para Empregados/normas , Indústrias/organização & administração , Serviços de Saúde Mental/normas , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Medicina do Comportamento/organização & administração , Medicina do Comportamento/normas , Serviços Contratados/normas , Estudos Transversais , Coleta de Dados , Gerenciamento Clínico , Planos de Assistência de Saúde para Empregados/organização & administração , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Indústrias/classificação , Auditoria Administrativa/estatística & dados numéricos , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/estatística & dados numéricos , Administração de Linha de Produção/normas , Estados UnidosRESUMO
With funding from the Administration on Aging, the National Resource Center: Diversity and Long-Term Care surveyed state administrators of programs serving elders in 24 states in 1994. This survey sought to document what written guidelines and training case managers receive in promoting client autonomy in care planning. In discussions with respondents and review of written materials provided by the states, surveyors explored whether clients received written information about services, the structure for seeking client input into care planning, and the structure for soliciting client feedback once the care plan was in place. Of the states included in this survey, few have developed and implemented guidelines or provide case managers training to promote client autonomy in the care-planning process. After reviewing the survey findings, the authors make two policy recommendations for states to consider in this area.
Assuntos
Administração de Caso/organização & administração , Guias como Assunto , Serviços de Saúde para Idosos/organização & administração , Participação do Paciente , Assistência Centrada no Paciente/organização & administração , Pesquisas sobre Atenção à Saúde , Humanos , Estados UnidosRESUMO
This article develops a framework for identifying community long-term care program and policy features that support or hinder client autonomy. After introducing the topic, the authors develop a contextual approach for understanding individual autonomy and discuss its relevance to community long-term care. They also illustrate how current financing, organization, and delivery of community long-term care provide clients with opportunities for meaningful choice. The authors summarize the implications that a contextual autonomy approach has for both community long-term care policy and program features and make specific policy recommendations.
Assuntos
Serviços de Saúde Comunitária/organização & administração , Liberdade , Assistência de Longa Duração/organização & administração , Participação do Paciente , Idoso , Administração de Caso , Política de Saúde , Humanos , Estados UnidosAssuntos
Planejamento em Saúde/normas , Recursos em Saúde/provisão & distribuição , Direitos Humanos , Modelos Teóricos , Justiça Social , Indexação e Redação de Resumos , Área Programática de Saúde/classificação , Demografia , Georgia , Nível de Saúde , Humanos , Estilo de Vida , Risco , Fatores SocioeconômicosRESUMO
PIP: Like most other public health agencies, the Georgia Department of Human Resources, Division of Public Health (DPH) has encountered a growing number of questions and conflicts with ethical implications. To address these and other questions, DPH started to develop a framework, in January 1985, specifically related to solving problems, setting priorities, and developing policy that adds an ethical perspective. DPH must deal with issues and conflicts that transcend the traditional model of medical care: with the new economic reality, programs must continue with less resources; medical technology is now raising questions, but not necesarily answers, related to life and death; and the rights and responsibilities of individuals and institutions are not clearly defined. In this context, DPH has started to examine ethical considerations with respect to the individual and the community. An interface exists between ethical theory and health care. Over the years, however, this relationship has assumed different manifestations, ranging from the formation of precise conduct codes for health care professionals to the establishment of review boards that examine specific morally questionable procedures. DPH's purpose in applying ethical theory to its health care practices is not to develop an inflexible code nor a committee to review isolated cases of moral conflict. The purpose is to use ethical theory as a form of vision for the remainder of the 1980s and beyond.^ieng