Cost containment and mental health outcomes: experiences from US studies.
BACKGROUND
Cost containment mechanisms, such as prepayment, are being considered or implemented in the US and elsewhere, but there have been few studies of the effects of such mechanisms on quality or outcomes of care for individuals with serious psychiatric disorders.


METHODS
Key results from US studies on cost containment and their implications are reviewed.


RESULTS
Cost savings in out-patient mental health care can be achieved through increasing the share of costs paid by the covered individual or through prepayment, but individuals with the greatest psychological distress or poor people may achieve worse outcomes under greater cost containment. Quality of care may be poorer under some forms of prepayment than under fee-for-service care, yet a national prospective payment mechanism for depressed elderly in-patients was not associated with a marked drop in quality or outcomes of care among those admitted.


CONCLUSIONS
Prepayment, relative to fee-for-service is not always associated with lower outcomes or quality of care for affective disorders. Under cost containment, quality and outcomes of care, especially for the sick poor, should be monitored to identify adverse consequences.
Wells
K B
KB
Neuropsychiatric Hospital, UCLA 90024, USA.
D001008:Anxiety Disorders / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation; D003363:Cost Control / Q000639:trends; D003866:Depressive Disorder / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation; D018588:Fee-for-Service Plans / Q000191:economics; D006299:Health Services for the Aged / Q000191:economics; D006801:Humans; D008329:Managed Care Programs / Q000191:economics*; D017061:Prepaid Health Plans / Q000191:economics; D011445:Prospective Payment System / Q000191:economics; D011785:Quality Assurance, Health Care / Q000191:economics; D016896:Treatment Outcome; D014481:United States