Managed mental health care: a home grown product.

Abstract

Public non-profit mental health services the Mentally Ill (NAMI) found that 70% of businesses agreed with the concept of parhave been the last entities in health care to be affected by the managed care revoluity. Thirty-two percent of businesses surveyed have already made changes in order tion. Managed care companies have been greatly concerned that services to the to comply, and another 43% said they were in the process of complying. Only mentally ill involve unpredictable costs. This fear is driven, in part, by the preva2% thus far have sought a waiver, and only 1% in the survey intend to drop their menlence of severe and persistent mental illness, along with legislation in most states tal health coverage. Maryland has reported to the National that entitles severely mentally ill persons, through Medicaid entitlements, to receive Institute of Mental Health (1998) that the total medical premium has decreased by as much mental health service as is deemed medically necessary. Concomi0.2% following compliance with the parity law. After Minnesota had been under partantly, data are beginning to show that fears about unpredictable costs are unity for 1 year, Blue Cross/Blue Shield reduced the premium for small businesses founded in states that have begun to introduce mental health parity. The Mental from 6 to 5%. North Carolina implemented parity in 1992, and has seen a decrease in Health Parity Act of 1996 requires annual and lifetime benefits for mental illness that mental health payments, as a percentage of total health payments, from 6.4 to 3.4% (a are on a par with those offered by employers. Employers are exempt if they have 50 47% reduction). Clearly, these results have been achieved through careful manageor fewer employees and/or if the benefit raises health premiums more than 1%. ment of mental health resources. In spite of these successes, the public A survey by the National Alliance for mental health system has been slow to change. Supported by mental health tax dollars in most large urban centers, nonWalter Smitson, Ph.D., is President and CEO of profit mental health and substance abuse Central Clinic, Cincinnati, and is Professor in agencies have long guarded their individthe Department of Psychiatry, University of Cinual turfs, and have effectively resisted efcinnati College of Medicine. forts to enter the domain of painful Address for correspondence: Walter S. Smitson, Ph.D., Central Clinic, 3259 Elland Ave., change. Instead, many agency executives Cincinnati, OH 45229-2801. and their boards have often developed