U.S. mental health policy: Doomed to fail.

Changes in the de facto system of mental health care in the last decade reflect organizational and entrepreneurial responsiveness to changes in health policy, not mental health policy. Various other actions described here reduced statutory or institutional leadership roles in mental health and increased the pace at which mental health policy was becoming dependent on health policy. In turn, US health policy in the 20th century has been inherently flawed. The short-term general hospital, the "doctors' workshop," emphasizing acute care and surgery, has been the cornerstone of US health policy throughout the 20th century. The mimicry of health services by mental health leads to demonstrably more expensive and less effective mental health care and dooms mental health policy to failure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

U.S. mental health policy: Proactive evolution in the midst of health care reform.

Argues that it is vital that psychological and behavioral health care perspectives be explicitly recognized during the coming reform of the US health care system. Mental health policy should not be treated as a mere extension of physical health policy; to do so extends all the flaws of the physical health system into the psychological care arena, resulting in a mismatch with the actual health care needs of the nation. Furthermore, organized psychology must remind policymakers that psychologists provide health services in areas of health care beyond mental health. The challenge to psychology is to ensure the continuation of adequate and timely access to appropriate psychological and behavioral health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health policy: Observations from Europe.

Reviews policies and practices based on a study of 5 European countries (Switzerland, England, Denmark, Sweden, and the Netherlands) with respect to deinstitutionalization and community support and rehabilitation services, health and social security benefits, financing mechanisms, and care for the homeless and young adult chronic populations. Common trends in European mental health and social welfare policies are summarized. Relative to the US, the coordinated system of care in these countries is supported by a strong social welfare system allowing for community-based care administered by the mental health service system. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services in a single payer system: Lessons from Canada and principles for an American plan.

Reviews the advantages of financing mental health care in the US along the lines of the Canadian single-payer system and argues that the pillars of the Canadian system (accessibility, comprehensiveness, portability, public administration, and universality) are standards a restructured US system could achieve. The merits of including mental health coverage in a basic benefits package are also discussed. The authors believe limits on reimbursement for psychologists in Canada should not keep US psychologists from supporting single-payer proposals because (1) the professional Zeitgeist in the US in 1992 is very different from that of Canada in the late 1960s and (2) Canadian psychologists could have participated but failed to achieve professional consensus on the merits of inclusion in the national health program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The academic health center and the healthy community

US medical care reflects the priorities and influence of academic health centers. This paper describes the leadership role assumed by one academic health center, the State University at Buffalo's School of Medicine and Biomedical Sciences and its eight affiliated hospitals, to serve its region by promoting shared governance in educating graduate physicians and in influencing the cost and quality of patient care. Cooperation among hospitals, health insurance payers, the business community, state government, and physicians helped establish priorities to meet community needs and reduce duplication of resources and services; to train more primary care physicians; to introduce shared governance into rural health care delivery; to develop a regional management information system; and to implement health policy. This approach, spearheaded by an academic health center without walls, may serve as a model for other academic health centers as they adapt to health care reform.     

Women and the 1993-1994 health reform debate: issues and questions

Provides a review of the major issues raised during the 1993-1994 national health reform debate, with emphasis on the implications of these issues for women's health. I begin with an overview of the current health care system and the access to care by women in it, based in part on their health characteristics. The need to reform the current system is noted, along with a discussion of the major issues and proposals debated during 1993-1994, the years of the 103d US Congress. Questions are raised that could enable women's health advocates and activist women health care consumers to assess the implications for women of various future health reform proposals.     

Mental health care: Access, stigma, and effectiveness.

Discusses the lack of commitment by the US as a nation to ensure that high-quality mental health care will be provided to all who are in need. The mental health benefits under Medicare and Medicaid programs are meager at best. Psychologists and other nonphysician health care providers are not considered bona fide professionals. Prevention, program evaluation efforts, and the use of alternatives to traditional inpatient care, such as halfway houses and crisis intervention programs, are not treated under the current reimbursement system. An "efficacy proposal" created by US Senators D. K. Inouye and S. M. Matsunaga is described. The essence of the proposal was modeled after the current Food and Drug Administration requirements for safety and efficacy for all new drugs and medical devices. In addition to these 2 requirements, the notion of "appropriateness" or "cost-effectiveness" was added. This proposal, which was deleted in 1980, would have established an interdisciplinary commission comprised of representatives of both the scientific and clinical communities. The commission would have been charged with the responsibility for making recommendations as to what types of mental health services, and under what conditions, should be reimbursed under the Social Security Act. It is concluded that the establishment of an independent entity with the charge of seriously reviewing the "probably public benefit" of providing psychotherapy would be in the national interest of the US. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health and aging: The need for an expanded federal response.

Discusses the mental health problems that may occur as elderly people must face adjustments because of bereavement, poor physical health, the demands of caring for an ill spouse, drug/alcohol abuse, dementia and cognitive impairments, and multiple health problems. Negative social stereotypes associated with both elderly patients and mental health care, limited access to and a lack of trained professionals in the area of geriatric mental health care, lack of outreach, inadequate benefits under prepaid health plans, Medicare and Medicaid, and special problems of ethnic minority and rural elderly people all contribute to an inadequate mental health care system. The author, a US representative, suggests a redesigning of the system and outlines an initiative that addresses the development of an effective mental health care system for the elderly, modification of Medicare and Medicaid, and improvements in quality assurance and access protection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dilemmas of child care in the United States: Employed mothers and children at risk.

Describes the lack of US policies and the research on child care needs, both for employed parents and for their children. Unlike all other industrialized nations, the US has not developed coherent policies on the twin initiations of parental leaves and quality child care. Although neither Canada nor the US have achieved the level of support for employed families that are common in Europe, the deficiencies of US policies are especially glaring. Given the high rates of maternal employment in both countries, the major issues are how to provide a comprehensive system of high quality child care for infants and young children and how to fund necessary services. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Provision of psychotherapy under managed health care: A growing crisis and national nightmare.

Managed care was intended to save money by eliminating unnecessary services. However, for both physical medicine and mental health care, it is easier to save money by simply cutting needed services. This is what is happening in managed care in the US today. However, data exist for arriving at reasonable procedures to provide real help and still be cost-conscious, a fact that is being ignored by managed care companies. The German national health system covers up to 300 sessions of psychotherapy if needed, but only 3% of their outpatient medical costs are used for such psychotherapy. Unfortunately, the American managed care systems aim at short-term cost savings, even if it means higher costs in the long run (or making patients go outside the managed care health plan for help or forgo getting psychological help at all). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent health: Reflections on a report to the U.S. Congress.

The Office of Technology Assessment (OTA) found that the conventional wisdom that American adolescents are so healthy that they do not require health and related services is not justified; US adolescents often face formidable barriers to obtaining needed health care, and relatively little appropriate attention has been paid to adolescents by the federal government. OTA suggested that Congress could act to (1) increase adolescents' access to health care by supporting comprehensive health services specifically for adolescents, (2) restructure the federal role in adolescent health by creating an office of adolescent health in the US Executive Branch, and (3) improve adolescents' social environments by providing more support to families of adolescents, limiting adolescents' access to firearms, supporting the expansion of their recreational opportunities, and further increasing opportunities for community service. Federal actions taken since OTA's report are summarized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The next wave of change for psychology and mental health in the health care revolution.

Recent national changes in the de facto system of health and mental health care are described. Although the percentage of people without health insurance (always or sometimes) has not decreased, the organization of insured care has changed dramatically. Of the insured population, 75% are under some form of managed care. For 88% of the managed care population, mental health care has not been integrated with health care: the so-called carve-out. The author argues that system integration (carve-ins), for a variety of reasons, will begin soon and will occur very rapidly. A tilt toward carve-ins will have substantial impact on psychologists' training, service delivery, and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Proposal for Canadian-style single-payer health care receives cool reception in US

Is health care reform dead in the US? It may be, if the reception given President Clinton's reform plan and a proposal for a single-payer program in California is any indication. There has been a dramatic move to the right south of the border, where people have lined up to oppose "big government" and additional government programs. Still, American proponents of a single-payer program similar to Canada's insist that the battle for reform is not yet over.     

Psychology and health.

This article traces the historical development of Canadian medicare and its significant influence on shaping not only the clinical services provided within Canada's public health care system but also its major impact on the nation's overall health research agenda. Particular emphasis is placed on how this has influenced the development and role of psychology in the public health care system. It is argued that all psychologists, whether their work is focused on the applied or experimental areas of the discipline, have much to offer Canadians across the entire health care spectrum. Nevertheless, psychological services in the public health care system, and particularly in hospitals, have mainly developed within and continue to be primarily focused around mental health. Services in nonmental health areas of health have been more limited, although their importance is well recognized. The current situation partly reflects the limited training in general health issues that clinical psychologists-in-training generally receive in many graduate school programs in Canada. However, it also reflects the overall influence of medicare on the development of Canada's health care system. Medicare has tended to focus the activities of Canada's health care system primarily on treating illness rather than on preventing it and/or maintaining health. Also, medicare has oriented Canada's health care system mainly toward delivering medical services rather than providing more comprehensive health services (e.g., the "medically necessary" criterion for funding). However, times are changing. The growing emphasis among health policymakers in Canada on illness prevention and health promotion (e.g., the creation of the federal government Public Health Agency of Canada in 2004) will significantly expand psychology's role across all areas of health. Psychology education and training programs are urged to seriously examine whether psychology practitioners and researchers are being adequately prepared at present for the much broader array of future interdisciplinary professional, research, and educational activities and responsibilities that will emerge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A health care system of one.

Health care has been, and to large measure remains, an enormous collection of considerably independent professionals, freestanding institutions, highly individualized consumer demands, and laws that vary considerably state by state. To a great extent, health services in the US have been organized and offered as an exchange between individuals, and American practitioners and patients have valued this independence. Over the past decade and a half, however, we have begun to recognize that provision of health care on an individuated basis comes at an enormous cost. Beyond simply the economic cost, there is the growing realization that the "independent" nature of the actions taken by the individuated sectors of our health system can often be characterized as idiosyncratic, unmanaged, uncoordinated, and irrational. One small but critical step toward improving the fractious nature of our health system is to advance the cause of states recognizing the professional licensure of health professionals by other states. Such mutual recognition, long overdue, promises real benefits for patients and, in the long run, for professionals as well. Professional bodies both private and public should focus on patients and their needs when considering any regulatory changes to be made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The child care crisis in America.

Argues that for almost 2 decades the American government has recognized the lack of affordable, good quality child care in the US as a serious and pressing problem. Despite this, the US has made very little progress in terms of instituting major reforms in regard to child care. The authors discuss how and why the child care problem in the US has turned to crisis proportions. In addition, they highlight the developmental concerns that surround the issue of child care, and the different child care options currently available for American families to choose from. Finally, they propose a possible solution to this problem; a solution that could carry the US into the 21st century. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gynecologic health and disease

Traditionally the obstetrician/gynecologist has been the sole provider of health care for women. As the United States moves toward a system of greater managed care, however, family practitioners, internists, and other physician extenders (physician assistants, nurse-practitioners, and nurse-midwives) are the first-line providers for many women. These practitioners have the opportunity to influence behavioral changes and promote healthy habits by identifying risk factors and their potential consequences.     

Health care megatrends and health psychology.

Reviews the literature for historical, educational, and health care delivery system contributors to the field of health psychology, which is a major new area of professional practice that has emerged during a period of rapid changes in the health care industry. Four megatrends in medicine and health care are discussed that impinge upon health psychology: the "demythologization" of medicine, changing patterns of medical practice, "remedicalization" of psychiatrists, and alterations in financing health care. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Observations on potential contributions of health planning

The passage of the National Health Planning and Resources Development Act in the United States in 1974 is used to set the context for a new assessment of health planning as a change agent. In reviewing the record of health planning the most striking conclusion is that even its friends have been unable to establish that it has had any quantifiable impact. The authors suggest, however, that comprehensive health planning may have stimulated the belief that changes in medical care organization are crucial to improving the health care system. The authors next consider the role of health planning inferred from three widely espoused "models" of the health care system: professional, central planning, and market. Although market advocates generally deemphasize health planning as contrasted to those supporting a centrally planned system, none of the models is sufficiently developed to indicate specific roles and functions fro health planning. Basing their argument on goals for health care reform generally espoused by students of medical care organization, the authors assert that health planning agenices will be most effective if they are organizationally linked to general-purpose governments, encourage the formation of Health Maintenance Organizations, consciously involve themselves in health system reorganization, and design their policies so they can be effectively evaluated.     

Anomalous left pulmonary artery without pulmonary artery sling

Although most news surrounding the declining dollar has concentrated on its impact on Canadian shoppers, economists say it is bound to affect the financially strapped health care system too. They point out that many of the good purchased by Canadian hospitals come from the US, and the weak loonie means their price will rise.