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The Economics of Mental
Health Care
It is now becoming widely
recognized that economic decisions effect how people are treated with mental
health disorders in our society. The desire for the state and federal
governments to reduce expenditures resulted in a deinstitutionalization movement
for example, in which many hospital patients were prematurely released into the
community. The current cost of the Medicare and Medicaid programs are also
significant topics of discussion by both the Democrats and Republicans currently
in political discussions throughout the popular media. It is expected that this
discussion will continue into the future.
On one hand, government
spending for people with psychological disorders has risen sharply over the past
three decades from $3 billion in 1969 to $61 billion at the turn-of-the-century,
although much of that money is spent on income support, housing subsidies and
other such expenses rather than directly for mental health services. Money for
direct care services actually appears to be decreasing.
There also has been somewhat
of a bias in funding medical care as opposed to mental health care. While
medical care under Medicaid is somewhat limited, payment for mental health
services in many circumstances is simply non-existent Medicare will pay 80% of
the expense incurred for medical services and only 50% for mental health
services, frequently making mental health services unaffordable for many
individuals.
The economic role of private
insurance companies has had an unprecedented effect on how clinicians now go
about their work. In an effort to maintain expenses, many companies have
developed managed-care programs in which the insurance company decides
which therapists their clients may choose, and the costs and number of sessions
to be reimbursed. Some of these insurance plans include cost controls of
expenses through the use of peer review systems in which clinicians who
work for the company review the provision of services periodically to determine
whether they should be continued or stopped immediately. Frequently, these
companies will require detailed information about the patient and their related
treatment.
Many therapists and patients
dislike managed-care programs and peer reviews for a multitude of reasons. Many
believe the required reports require a therapist to breach confidentiality even
when efforts are made to protect privacy as much as possible. Also, it is
believed that the true value of therapy is frequently unable to be briefly
summarized in treatment summaries or the progress notes of therapists. In an
effort to maintain costs, it is also believed that therapy that would be
maintained over a longer period of time is not reimbursed for reasons related to
cost savings rather than providing effective treatment. Brief therapies with
more short-term results (for example, such as drug therapy) are frequently
favored over more costly approaches which would provide longer-term and more
effective improvement. Almost all therapists are aware of horror stories in
which services are no longer reimbursed for necessary treatments resulting in
tragic consequences. In short, many therapists and counselors believe that
psychotherapy and the provision of mental health treatment is now more regulated
by insurance companies for cost purposes rather than mental health clinicians
for treatment benefits.
Information
from Ronald J. Comer’s Abnormal Psychology
Additional
Information and webpage by
Paul Susic
MA
Licensed Psychologist Ph.D. Candidate
(Health and Geriatric Psychologist)
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