A primer for advancing psychology in the public sector.

Psychologists working in the public sector should, in addition to providing direct services, advocate for systems change. Although many consumers treated in the public sector face a constellation of severe life problems, working to improve the system of care is more difficult than providing treatment. Improving the quality of life of consumers of publicly funded mental health services requires that psychologists become advocates. Four prerequisites to systems change, plus coalition building, legislative advocacy, the work of state psychological associations, and forming alliances between psychologists and nonpsychological community organizations such as Rotary International, are described. In conclusion, 12 orienting ideas are listed for psychologists who want to advocate for social, institutional, and political change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Public policy and the provision of psychological services to older adults.

Public policy shapes who delivers health care, how care is delivered, and how much providers are paid. The impact of public policy will become even more important to psychologists who serve older adults as 76 million members of the so called “baby boom” generation enter their later years. Armed with basic public policy facts, psychologists can better maneuver the systems created by public policy and even change policy. This article reviews how Medicare works since it is the primary payer of mental health services for older adults. The article then turns to the question of how many health care professionals (including psychologists) will be required to meet the needs of a rapidly growing older population and concurrent challenges of training and building that work force. Finally, different policy visions for a better mental health care system for older adults are summarized since they may be roadmaps to what the future of mental health care will look like. The article closes with practical recommendations on how psychologists can influence mental health and aging public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The growth of corporate private hospitals in Malaysia: policy contradictions in health system pluralism

The rapid growth of corporate investment in the Malaysian private hospital sector has had a considerable impact on the health care system. Sustained economic growth, the development of new urban areas, an enlarged middle class, and the inclusion of hospital insurance in salary packages have all contributed to a financially lucrative investment environment for hospital entrepreneurs. Many of Malaysia's most technologically advanced hospitals employing leading specialists are owned and operated as corporate business ventures. Corporate hospital investment has been actively encouraged by the government, which regards an expanded private sector as a vital complement to the public hospital system. Yet this rapid growth of corporately owned private hospitals has posed serious contradictions for health care policy in terms of issues such as equity, cost and quality, the effect on the wider health system, and the very role of the state in health care provision. This article describes the growth of corporate investment in Malaysia's private hospital sector and explores some of the attendant policy contradictions.     

Mixed Professional Corporations.

In this article, the author argues that it is past time for psychology to regard itself simply as a mental health profession and to recognize itself as the health profession it is. It is as broad as the state acts that license, certify, or register its practice. It is as broad as direct recognition/freedom of choice state laws delineate. It is noted that many psychologists in practice have established cordial referral and other working relationships with family practitioners, pediatricians, internists, psychiatrists, and other medical specialists. Generally, these interdisciplinary relations are informal and based on mutual regard. Occasionally, the basis is joint membership in a business, as distinct from a professional corporation. Over 20 states have laws that proscribe organized group practice. However, if private sector health care delivery is to be comprehensive, effective, and viable, a medium must be found to enable health practitioners of different disciplines to engage in professional corporate practice as colleagues. A new California law helps set the stage and may prove to be a useful model. With this law, California becomes the third state in which psychologists can engage in multidisciplinary corporate practice with physicians. By enabling the formation of multidisciplinary professional corporations wherein psychologists and physicians may practice as colleagues, these laws open a new avenue for the delivery of this broadened range of professional services to the public and further establish, in statute, a collaborative basis for practice among psychologists and physicians. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Musings of a bureaucratic psychologist.

The value of having a background in both experimental and clinical psychology is evaluated from the perspective of an essentially administrative career. The opportunity to have a significant impact on major public policy issues is an important factor in choosing to become involved in a state bureaucracy. Some of the reasons why states have recently turned to managed care for mental health services are explored. The fact that psychologists have not taken an aggressive role in helping to define how public agencies should move into managed care is unfortunate, both from a public policy standpoint as well as for the future of the profession. The future role of psychologists in the changing mental health-managed care environment is also reviewed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological consultation with primary care physicians: Obstacles and opportunities in the medical setting.

This article discusses the relationship between psychologists and primary care physicians and describes the training and practice of physicians in the areas of mental and behavioral health care. Issues affecting the relationship between psychologists and primary care physicians are then reviewed. Different models of psychological consultation are discussed, and an integrated behavioral systems model of psychological consultation is presented as a potentially effective model for consultation with primary care physicians. This model provides a framework for psychologists to function as coproviders of primary health care services. Practical strategies to enhance collaboration between psychologists and primary care physicians in private practice are discussed. The need for more research on primary care and for the inclusion of psychologists in managed care and health care reform are also highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of psychologists in the care of Iraq and Afghanistan veterans in primary care settings.

Although military personnel serving in Iraq and Afghanistan are at high risk of developing mental health problems, many report significant barriers to care and few seek help. Integrated primary care is a comprehensive model of health care that aims to improve access to care and provides a framework to assess and meet the complex psychiatric needs of newly returning veterans by embedding mental health specialists within primary care. We describe the role of psychologists in a Department of Veterans Affairs (VA) integrated primary care clinic that serves veterans of Iraq and Afghanistan. Psychologists based in primary care can assist veterans with reintegration to civilian life by providing rapid mental health assessment, normalizing re-adjustment concerns, planning for veterans’ safety, implementing brief interventions within primary care, facilitating transition to additional mental health care, and informing veterans of other available psychosocial services. A case example demonstrating the psychologist’s role highlights the benefits of an integrated care model. Implications of employing this model include reduction of symptoms and impairment by reducing stigma and barriers to seeking mental health care, increased motivation to engage in treatment, and implementation of early interventions. This model may also be beneficial in the civilian health care sector with groups that are at high risk for mental health problems, yet experience barriers to care, particularly stigma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who is for children?

Discusses some of the unmet needs of children in the areas of mental health care, day care, and foster and institutional care. It is argued that children with serious emotional problems do not get the treatment they need because adequate funds have not been set aside for children's mental health and because few incentives exist to serve children in community settings or in the most familylike settings possible. Specific functions that can be served by psychologists are presented, and strategies for creating public and private sector policies more responsive to the needs of children and their families are outlined. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Privatization and the mental health system: A private sector view.

Privatization has received significant attention in the popular and professional press. The notion has gained increasing political acceptance with the private sector being seen as cost-effective, innovative, and responsive. Private mental health initiatives will grow because the private sector is seen as an efficient allocator of resources and because there are profit opportunities in traditionally public services. However, a partnership between the private and public sectors will be required in planning and development, serving difficult groups, and defining and measuring quality of care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric care and health insurance reform

Concerns about cost, access, and quality of health care in the United States have led to a variety of legislative proposals that would reform our health care system and its financing. Health insurance benefits for mental illness, including substance abuse, are treated differently from medical/surgical benefits, with stricter limits on outpatient visits and hospital days. Medicare, Medicaid, and most private health insurance plans contain this historic disparity of coverage for mental illness compared to general medical illness. Psychiatric services are also distinguishable because of the large public sector reimbursement for mental illness treatment and support. Principles for a more equitable design of mental health benefits include a non-discriminatory approach; payment on the basis of service rather than diagnosis; application of cost containment for care of mental illness on the same basis as care of general medical illness; retention of the public sector as a backup system for high-cost, long-term care; encouragement of lower-cost alternatives to the hospital through the development of a continuum of care; and a recognition of the distinction between psychotherapy and medical management. All current approaches to universal health care fall short of these principles. A research agenda is needed now more than ever in order to articulate the case for complete coverage of mental illness and substance abuse.     

Health care markets in Australia: ownership of the private hospital sector

Over the past decade, the Australian hospital sector has undergone a massive economic and administrative reorganization with ramifications for both the private and the public sectors. Changes such as privatization, deregulation, and the entry of foreign capital into the hospital sector are occurring in the hospital systems of many countries, including Australia, the United States, and the United Kingdom. These developments are radically transforming the hospital sector, altering established relationships between the state, the medical profession, the consumer, and the corporate investor, and raising important questions about the future of hospital services in regard to equity, accessibility, and quality.     

Running for political office: If at first you don't succeed….

Psychologists are serving in several state legislatures and gaining firsthand experience as political candidates. This article chronicles a psychologist's 1994 campaign for the Washington State House of Representatives. Campaign vignettes, political strategies, and the candidate's personal perceptions illuminate the value (even necessity) of psychologists entering politics. Psychologists bring to legislative deliberations a strong fund of knowledge about critical social issues such as health care, violence, and children's needs. Psychologists also possess effective interpersonal and group dynamic skills that can be real assets in developing public policy. A commitment to advocacy for mental health services and a community service ethic provide motivation for seeking office; indeed, entering politics can be viewed more as a logical extension of psychological work than as a deviation from it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of psychotherapy as the basis for public policy.

Discusses the tremendous growth that has occurred in the number of mental health providers, the rate of use of mental health services, and public and private reimbursement for mental health care. Governmental policymakers and leading insurance officials continue to seek information regarding the appropriateness and efficacy of specific psychotherapeutic techniques with various types of presenting problems. The efforts during the Carter administration to stimulate additional efficacy research and knowledge synthesis regarding the efficacy of psychotherapy are described. A public policy proposal is forwarded that no form of health intervention—physical or mental—should be supported through 3rd-party reimbursement and publicly supported training programs unless it has been demonstrated to be safe and effective. It is argued that randomized controlled clinical trials should be viewed as the most valid, though not exclusive, source of evidence. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Third world medicine in first world cities: capital accumulation, uneven development and public health

This paper addresses issues of public health and access to care for the urban poor in the context of current U.S. urban, economic and industrial policy. The pathologies that threaten "inner city" neighborhoods are the result of decades of political neglect, economic exploitation and resource withdrawal, which themselves stem directly from public and corporate sector strategies to facilitate capital accumulation and consolidation. The resulting conditions of uneven development between wealthy and impoverished local sectors mirror similar relationships between First and Third World countries. These same patterns are reflected and reproduced in the health care "industry" itself, where growing corporate dominance has developed alongside a concomitant reduction in support for public sector and community-based care. These trends create and exacerbate conditions that place poor and minority populations at risk. Community development and political empowerment, as well as the overall corporate hegemony that increasingly characterizes the political economy of the U.S.A., are essential public health considerations that must be included in any meaningful health policy or health care reform proposals.     

Public and private responsibility for mental health services: A report on the Tennessee task force.

The "privatization" of mental health services during the last decade has literally reshaped the way state and county departments of mental health go about fulfilling their statutory responsibilities. In Tennessee, a conference and later a task force examined the implications of this trend for the future. Two issues came to the forefront: Is it appropriate or possible for the private sector to take over the delivery of all mental health services, and if so, who will ensure that the poor receive adequate care? The Tennessee task force concluded that the privatization trend is appropriate and should be encouraged by government. It further concluded that government is ultimately responsible for ensuring access to care for the poor and uninsured although private facilities should provide some free care. Government best serves the poor by providing them the financial means to purchase care from private providers. (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)     

Interview with Representative Cecil Heftel.

Heftel discusses (a) reasons for spiraling health care costs; (b) why cost-saving alternatives such as nonphysician practitioners (e.g., psychologists) have been excluded from Medicare coverage; (c) the Heftel and Inouye bill providing Medicare coverage of psychologists' services in health maintenance organizations; (d) the need to increase in general Medicare coverage of mental services for the elderly; (e) the high incidence of mental illness in the elderly; (f) lower usage of mental health services among the elderly compared to younger groups; (g) mental health services in Hawaii; (h) the issue of psychologists as independent practitioners within Medicare; (i) involvement of psychologists in political advocacy; and (j) use of media by behavioral sciences to promote their concerns. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services in the public and private sectors

Analysis of data on mental health service providers indicates that in 1971 the private sector accounted for 34% of inpatient days, 86% of outpatient visits, 44% of expenditures by source of funds, and 51% of expenditures by receipt of funds. The author believes that mental health professionals must familiarize themselves with the economic interests influencing national health insurance proposals and with public policy making processes if they are to help preserve appropriate roles for the public and private sectors in mental health service delivery.