32 - Economic Issues and Geriatric Mental Health Care

Abstract

Publisher Summary This chapter highlights the key financial and economic issues that affect the psychiatric care of older adults. The specific details regarding reimbursement of geropsychiatric services are also provided in the chapter. The chapter further describes the recent changes in third-party payment schemes. The economic profiles and the health care needs of older adults are extensive, diverse, and complex. Despite extraordinary expenditures and recent policy improvements, enormous financial and organizational barriers to geriatric mental health care persist. Medicare policy has been the cornerstone of the organization and delivery of geriatric psychiatric services for nearly a quarter of a century. High co-payments, service limitations, and poor reimbursement for services have reinforced discrimination and stigmatization of care for this rapidly growing population with established acute and chronic needs. Recent legislation could begin to improve access to mental health services for older adults. New policies will open the door for a large group of providers to deliver services to the elderly. Additionally, the spirit of innovations in cost containment may reward the work inherent in the cognitive and caring activities of psychiatric providers. However, these steps are small and incremental, and they are superimposed on a fragmented system of care that has not reinforced quality or innovation. As this population grows in size, need, and influence, policymakers and mental health providers will be challenged to design a more comprehensive system that reduces systematic barriers to care. Direct reimbursement of nonphysician specialty mental health providers may allow new models of service delivery for older adults to emerge.