Utilization management of mental health services by private third parties.
The author describes approaches to utilization management and the growth of this segment of the health care industry. Issues posed for the mental health field by introducing a third party as the arbiter of care include professional uncertainty and the discretionary behavior of practitioners and third parties, the availability of clinically appropriate alternative services, shifting of costs between the public and private sectors, safeguarding privacy, accountability and the integrity of the review process, financial risk versus professional responsibility, and the impact of utilization management on the outcome of care.
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519.
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Tischler
D003363:Cost Control; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence; D007349:Insurance, Health, Reimbursement; D007902:Length of Stay / Q000191:economics; D008329:Managed Care Programs / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000191:economics*; D014481:United States; D014600:Utilization Review