GERIATRIC PSYCHIATRY AND MANAGED CARE - 06/09/11

Doi : 10.1016/S0193-953X(05)70170-2

Gary S. Moak, MD ^{^{*
Department of Psychiatry, University of Massachusetts School of Medicine; Geriatric Services, Capstan, LLC, Worcester; and Custom Medical Billing, Inc., Concord, Massachusetts}}

Résumé

The elderly with late-life psychiatric disorders have been ill served by all sectors of the American mental health care system. The track records of both the public mental health system and the private fee-for-service sector have been dismal. Managed care organizations (MCOs) bring approaches to service delivery that offer a potential for improved outcomes in mental health care for elderly.^{7 Kane R.L. Managed care as a vehicle for delivering more effective chronic care for older persons J Am Geriatr Soc 1998 ; 46 : 1034-1039

Cliquez ici pour aller à la section Références, 8 Lachs M.S., Ruchlin H.S. Is managed care good or bad for geriatric medicine? J Am Geriatr Soc 1997 ; 45 : 1123-1127

Cliquez ici pour aller à la section Références, 14 Wagner E.H. The Promise and performance of HMOs in improving outcomes in older adults J Am Geriatr Soc 1996 ; 44 : 1251-1257

Cliquez ici pour aller à la section Références} Unfortunately, psychiatric treatment of the elderly under managed care has not realized this promise and has been fraught with its own limitations.^{2 Bartels S.J., Colenda C.C. Mental health services for Alzheimer's disease. Current trends in reimbursement and public policy, and the future under managed care Am J Geriatr Psychiatry 1998 ; 6 (suppl) : 85-100

Cliquez ici pour aller à la section Références, 3 Colenda C.C., Banzak D., Mickus M. Mental health services in managed care: Quality questions remain Geriatrics 1998 ; 53 : 49-63

Cliquez ici pour aller à la section Références, 12 Unitzer J., Katon W., Russo J. , et al. Patterns of care for depressed older adults in a large-staff model HMO Am J Geriatr Psychiatry 1999 ; 7 : 235-243

Cliquez ici pour aller à la section Références, 13 Unitzer J., Patrick D.L., Simon G. Depressive symptoms and the cost of health services in HMO patients aged 65 years and older JAMA 1997 ; 277 : 1618-1623

Cliquez ici pour aller à la section Références}

MCOs face daunting challenges in attempting to provide better care to elderly members. They must manage the high cost of care for frail patients with multiple problems in a world of shrinking reimbursement while creating innovative service delivery systems that overcome barriers elderly patients face to receive quality care. This article reviews the current status of mental health care of the elderly under managed care and describes the unique problems and opportunities facing managed mental health care systems.

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