Comparison of public/private health care insurance parameters for independent psychological practice.

Managed care cost-cutting strategies are more prevalent in the private (employer provided) than public (Medicare/Medicaid) health care sectors. The main organizational managed care strategy pertaining to the independent practice of psychology has been the separation of the administration of mental from medical health care though behavioral health carve-outs. These organizations typically offer lower reimbursement rates and have greater preauthorization requirements than non-managed care public plans for the same psychological service. Dispute resolution in the private sector involves lawsuits and state consumer protection programs while public plans utilize internal review and are subject to investigations of provider billing fraud and abuse. Behavioral health carve-outs have reduced mental health care utilization rates with unknown effects upon outcome. There is some evidence that psychologists have chosen to limit practice within the private sector, but national data on the overall effect is lacking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Access to health care services among people with rehabilitation needs receiving Medicaid.

Objective: To investigate access to care for individuals with rehabilitation-related conditions receiving fee-for-service Medicaid. Study Design: Telephone survey. Participants: One hundred thirty-eight individuals with spinal cord injury (SCI), brain injury (BI), or stroke. Main Outcome Measures: Frequency of difficulty or failure to access medical services, perceived effect on health, services most difficult to access, and reasons for difficulty. Results: People with SCI reported the most frequent difficulty accessing services (87%), followed by persons with BI (79%) and stroke (65%). In a subgroup of respondents, 60% reported failure to receive at least 1 service; 81% reported that access difficulties affected health or daily routine. Conclusions: People with rehabilitation-related disabilities may experience greater barriers to needed services than the larger population of persons with disabilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care reform in the states.

Challenged by relentless increases in health care spending, state governments have been forced to experiment with health care system reform. Medicaid has been expanded by Congress, forcing states to provide a broader array of health benefits to more recipients. As states consider reform, federal limitations mandated by Medicaid and by the Employee Retirement Income Security Act (ERISA) of 1974 on state activity pose significant obstacles. ERISA sharply limits a state's ability to raise revenue to fund these health programs. Several states have responded to these limitations by seeking waivers. Despite these obstacles, 8 states already have enacted comprehensive health reform measures, and virtually every state is considering legislative reform. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology can be indispensable to health care reform and the patient-centered medical home.

The Patient Protection and Affordable Care Act (PPACA) was passed into legislation in March 2010, making health care reform a reality. Perhaps the most well-developed model of primary care that aligns with the PPACA's agenda is the patient-centered medical home (PCMH). Integrated care, as defined by collaborative care between mental health and primary care providers and systems, will undoubtedly play a critical role in the success of the PCMH. The role of psychology and integrated care in the PCMH as well as training implications for psychologists are discussed. This article is intended to challenge our discipline to embrace psychology as a health care profession that must prepare for and solidify its added value in the health care delivery models of the future. Requisite skill sets for primary care psychologists and existing training opportunities are presented. Finally, possible mechanisms for training psychologists in integrated care and the professional roles primary care psychologists can expect to fill are proposed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Health Services and Health Care Economics: The Health Psychology Marketplace.

In an effort toward cost containment, the health care system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other health care specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists in Schools of Public Health: Current Status, Future Prospects, and Implications for Other Health Settings.

The deans and departmental chairs of the 22 schools of public health were asked in 1981 to list all psychologists holding full-time faculty appointments and the names of courses with a substantial behavioral/psychological content. Responses were received from 98% of the departments. The psychologists were then sent a survey concerning their backgrounds, job responsibilities, and satisfaction/dissatisfaction with their positions. There was an 80% response rate. Psychologists accounted for 5.7% of the approximately 1,300 full-time faculty in schools of public health. Psychologists represented a larger percentage of the faculty in departments of behavioral science than in departments of epidemiology, biostatistics, environmental health, and so forth. Public health psychologists were active researchers and publishers, with average totals of 2.5 articles and 26.9 citations for a three-year period. The primary advantages of employment in a school of public health had to do with an appreciation of the public health perspective, an interdisciplinary orientation, and research opportunities. The primary dissatisfactions cited were financial insecurity, isolation from psychology, and lack of appreciation among public health colleagues of the contribution of psychology to public health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care reform and psychological practice in schools.

National policy calls for the placement of comprehensive, customer-oriented, and accessible health and social services programs for America's children and youth. Schools have been targeted as the ideal location for such services. Numerous models of school-based and school-linked programs have been initiated. The role of psychology in these emerging models and programs is highly variable; however, it is an essential service that increasingly is being recognized as necessary in order for schools to address complex and diverse student and staff health needs. In this article, models for the delivery of school health services are profiled. Implications for practitioners who currently work in schools and for psychologists who are not currently working in schools but who are interested in maximizing psychology's contribution to school health services are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists and Mental Health Programs.

The author expresses surpise hat the APA Board of Directors is concerning itself with the relationship of the psychologist to mental health activities (Amer. Psychologist, 1954, 9, 208). But more surprising was the Board's impression that "medically dominated 'do-good' organizations" might be to blame for the lack of more active participation by psychologists. The author explains why he does not share this perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Rural Hawai'i Behavioral Health Program: Increasing access to primary care behavioral health for native Hawaiians in rural settings.

Health care access issues present significant challenges for rural populations and health providers. Psychology can support improved access and quality of rural health services through the development of integrated behavior health programs within primary care settings. This article reviews a clinical training and service delivery program, the Rural Hawai'i Behavioral Health Program, which has evolved in response to the pressing health needs of Native Hawaiians in rural communities. Native Hawaiian cultural factors and components of the primary care model that have supported the development of this program will be reviewed. Program expansion, sustainability, and treatment efficacy research will be discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral Activation Group Therapy in Public Mental Health Settings: A Pilot Investigation.

Depression is among the most common psychiatric disorders seen in mental health practices. Although effective treatments for the condition exist, managed care pressures providers to utilize empirically supported, cost-effective treatments. Behavioral activation (BA) treatment for depression has emerged in recent years as a promising, cost-effective intervention for major depressive disorder. If its effectiveness could be established. BA delivered through a group format would offer additional cost effectiveness over its individual therapy counterpart. This investigation examined the effects of behavioral activation group therapy (BAGT) for depression in public mental health settings. The results suggest that BAGT can be a valuable addition to the practicing psychologist's set of interventions to use with depressed clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care reform: The 1993–1994 evolution.

Health care costs in the US continue to increase, as does the number of individuals who lack health care coverage. The magnitude of these critical problems assures that reform of the health care system will continue to be debated over the next decade. Increasing health care costs are associated with increased complexity of services and a greater number of health care providers. As health costs increase and the number of individuals covered by private insurance decreases, states will face increasing pressure to develop effective methods of providing coverage for those without health insurance. Employer mandates will be viewed as one method of extending health coverage. Psychologists must be involved in policy issues so as to ensure the utilization of psychological knowledge and attention to psychological and behavioral health needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Commentary: Health care for the whole person.

This article summarizes the rationale for and history of Ronald F. Levant's 2005 American Psychological Association Presidential Initiative, "Health Care for the Whole Person," from which this special section originated. This initiative was intended to have both practice and policy implications in the application of the biopsychosocial model. The articles in this series present the rationale for and details of this integrated model in terms of research, economics, rural applications, and women's health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public Health and Psychology: An Important, Expanding Interaction.

The authors opine that the behavioral sciences and the field of psychology are absolutely vital in meeting the nation's needs regarding health and health policy. Psychologists have become increasingly involved in health psychology, as reflected by the establishment and rapid growth of Division 38 (Health Psychology). This expansion of psychologists' involvement in physical health research and intervention has led to increased contact between psychologists and nurses, public health experts, and nonpsychiatric physicians. With such contact, psychologists are being recruited into the faculties of schools of nursing, schools of public health, and schools of medicine. This article examines aspects of psychology's role in, involvement with, and contribution to one sector of this arena--public health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The masquerade of mental health reform: Comment on Bagby, Silverman, Ryan, and Dickens (1987).

In a valuable paper, Bagby, Silverman, Ryan, and Dickens (see record 1987-32403-001) analyzed rates of involuntary admissions to Ontario psychiatric facilities for several years before and after Ontario's civil commitment law was changed in November, 1978. Bagby et al.'s paper is timely and important because it is relevant to North America generally, as yet another instance of disparity between change in the semantic formulation of the law and the subsequent behaviour of the psychiatric establishment. It still remains entirely a separate ethical question as to what extent commitment criteria, if the notion is meaningful and enforceable at all, should in fact be as restrictive as Ontario appeared to have intended a decade ago. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

AIDS.

Introduces the topics covered in this Psychology in the Public Forum section of the journal. The authors of the articles that are part of this section believe AIDS is a problem that calls for psychology's involvement in designing research, in carrying out that research, in treating people with AIDS, in the development of public health programs, and in making active efforts toward prevention. The author of this article briefly discusses the topic and content of each of the articles included in this section. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Public Health Psychologist: An Ounce of Prevention Is Not Enough.

An increasing number of health service providers in psychology are working in non-mental-health areas in behavioral health and in community health programs. Much of the psychological work in prevention, wellness, and health promotion has ignored the contributions of public health. This article describes a joint MPH/PhD program recently established on two campuses of the University of Alabama system. The value of the dual perspectives is illustrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Economic aspects of anesthesia. I. Health care reform in the German Republic

Implications for Hospitals and Departments of Anaesthesiology. This article outlines the new German health care laws and their impact on the statutory health care system, hospitals and anaesthesia departments. The German health care system provides coverage for all citizens, although financial support from the public sector is on the downgrade. Hence, pressure to reduce public sector health care spending is likely to continue in the near future. Hospital costs account for one-third of total health care spending in Germany, and hospitals are facing increasing economic constraints: the volume and the charges for specific medical treatments are negotiated between the hospitals and the insurance agencies (or sickness funds) in advance. Only part of hospital care is still reimbursed on the basis of a per diem rate, and an increasing number of services are based on fixed payments per case or treatment. Reducing the costs for this treatment is therefore of utmost importance for hospitals and hospital departments. The prospective payment system and the pressure to contain costs demand a controlling system that allows for cost accounting per case. However, an economic evaluation must include comparative analysis of alternative therapeutic options in terms of both costs and outcome. Economic aspects challenge the traditional relationship between physicians and patients: doctors are still the advocates of their patients, but also act as agents for their institutions. Nevertheless, not only economic issues, but also ethical priorities and the value of an anaesthetic practice must be considered in the era of cost containment. Anaesthetists must be actively involved in providing high-quality care with its obvious benefits for the patient and be able to resist efforts to cut out expensive treatment modalities regardless of their benefits.