Health care reform offers opportunities to improve the care of persons with serious mental illness, but it also can lead to the disruption of innovative systems of care that have been developed in recent years through Medicaid and other public programs.
The care of mentally ill persons must be organized to maximize possible trade offs between inpatient and other community services in a way that will promote function and satisfactory adjustment.
An indemnity approach emphasizes controls on demand ; instead, better design of supply-side approaches is required, using incentives to integrate services through case management and other methods.
Considerable capacity development is needed to integrate long-term care appropriately into the mainstream, but serious barriers include control of risk selection and the difficulties of fairly adjusting capitation rates for high-utilization patients.
Issues in mental health care are paradigmatic of many other areas of medical care and reflect changing family and community organizations and new challenges in care and rehabilitation.
Mots-clés Pascal : Santé mentale, Dépense, Santé, Etats Unis, Prise en charge
Mots-clés Pascal anglais : Mental health, Expenditure, Health, United States, Treatment costs paid for by the health insurance fund
Notice produite par :
ENSP - Ecole nationale de la santé publique (devenue EHESP)
Cote : 93 V
Code Inist : 002B30A01B. Création : 199501.