Skip to main content
SpringerLink
Log in

The impact of private utilization management on psychiatric care: A review of the literature

  • Regular Articles
  • Published:
The journal of mental health administration Aims and scope Submit manuscript

Abstract

Psychiatric care in the United States is increasingly practiced subject to some form of utilization management (UM) by third parties. This paper reviews recent studies of UM in the privately insured mental health sector, and finds some limited evidence that UM reduces utilization and costs to the payer. Less is known about UM’s effect on mental health outcomes, or its financial impacts on patients, providers, and society. Implications concerning the regulation of UM are discussed, and suggestions are made for future research on the impact of UM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Woolsey C: UR, A 1980s innovation, is today’s staple.Business Insurance 1991; 25(7):19.

    Google Scholar 

  2. Tischler GL: Utilization management of mental health services by private third parties.American Journal of Psychiatry 1990; 147(8):967–973.

    CAS  PubMed  Google Scholar 

  3. Field MJ, Gray BH: Should we regulate ‘utilization management’?Health Affairs 1989; 8(4): 103–112.

    Article  CAS  PubMed  Google Scholar 

  4. Perlman BB, Melnick G, Kentera A: Assessing the effectiveness of a case management program.Hospital and Community Psychiatry 1985; 36(4):405–407.

    CAS  PubMed  Google Scholar 

  5. Zusman J: Utilization review: theory, practice and issues.Hospital and Community Psychiatry 1990; 41(5):531–536.

    CAS  PubMed  Google Scholar 

  6. Hamilton JM:Psychiatric Peer Review: Prelude and Promise. Washington, DC: American Psychiatric Press, 1985.

    Google Scholar 

  7. Gabel J, Jajich-Toth C, de Lissovoy G, et al.: The changing world of group health insurance.Health Affairs 1988; 7(3):48–65.

    Article  CAS  PubMed  Google Scholar 

  8. National Association of Private Psychiatric Hospitals 1990 Survey on Utilization Management Firms Conducting Psychiatric Review. Washington: NAPPH, 1990.

    Google Scholar 

  9. LaSota J: Growth in psychiatric services spurs call for utilization review.Business Insurance 1989; 23(8):24–26.

    Google Scholar 

  10. Melnick SD, Lyter LL: The negative impacts of increased concurrent review of psychiatric inpatient care.Hospital and Community Psychiatry 1987; 38(3):300–302.

    CAS  PubMed  Google Scholar 

  11. Docherty JP: Myths and mystifications of managed care.Journal of Mental Health Administration 1990; 17(2):138–143.

    CAS  PubMed  Google Scholar 

  12. Borenstein DB: Managed care: a means of rationing psychiatric treatment.Hospital and Community Psychiatry 1990; 41(10):1095–1098.

    CAS  PubMed  Google Scholar 

  13. Sharfstein SS: Utilization management: managed or mangled psychiatric care?American Journal of Psychiatry 1990; 147(8):965–966.

    CAS  PubMed  Google Scholar 

  14. Sullivan S, Flynn TJ, Lewin ME: The quest to manage mental health costs.Business and Health 1987; 4(4):24–28.

    CAS  PubMed  Google Scholar 

  15. Gilbride D: Managing psychiatric care: a better way to control costs.Employee Benefits Journal 1987; 12(4):27–31.

    CAS  PubMed  Google Scholar 

  16. Frank RG, Lave JR: Some economic aspects of managed mental health care. In: Feldman S (ed.):Managed Mental Health Care. Springfield, Ill.: Charles C. Thomas, 1992, pp. 83–99.

    Google Scholar 

  17. Milstein A, Oehm M, Alpert G: Gauging the performance of utilization review.Business and Health 1987; 4(4):10–12.

    CAS  PubMed  Google Scholar 

  18. Frank RG, Salkever DS, Sharfstein SS: A new look at rising mental health insurance costs.Health Affairs 1991; 10(2):116–123.

    Article  CAS  PubMed  Google Scholar 

  19. Walker JD, Aquilina D, Needle PR: Managing mental health costs.Health Span 1986; 3(10):11–15.

    CAS  PubMed  Google Scholar 

  20. Feldman J: Response to clinical issues raised on managed care.Journal of Mental Health Administration 1990; 17(2):168, 169.

    Google Scholar 

  21. Goldstein JM, Bassuk EL, Holland SK, et al.: Identifying catastrophic psychiatric care cases: targeting managed care strategies.Medical Care 1988; 26(8):790–799.

    Article  CAS  PubMed  Google Scholar 

  22. Goldstein LS, Browne PE: Identifying clinical appropriateness in the catastrophic psychiatric case.Journal of Mental Health Administration 1990; 17(2):161–167.

    CAS  PubMed  Google Scholar 

  23. Wenzel L: From insured to managed mental health care.Health Span 1986; 3(10):3–10.

    CAS  PubMed  Google Scholar 

  24. Seltzer DA: Limitations on HMO services and the emerging redefinition of chronic mental illness.Hospital and Community Psychiatry 1988; 39(2):137–139.

    CAS  PubMed  Google Scholar 

  25. Wickizer TM: The effect of utilization review on hospital use and expenditures: a review of the literature and an update on recent findings.Medical Care Review 1990; 47(3):327–363.

    CAS  PubMed  Google Scholar 

  26. Lerner M, Salkever DK, Newman JF: The decline in the Blue Cross Plan admission rate: four explanations.Inquiry 1983; 20:103–113.

    CAS  PubMed  Google Scholar 

  27. Feldstein PJ, Wickizer TM, Wheeler J: Private cost containment: the effects of utilization review programs on health care use and expenditures.New England Journal of Medicine 1988; 318(20):1310–1314.

    Article  CAS  PubMed  Google Scholar 

  28. Wickizer TM, Wheeler JRC, Feldstein PJ: Does utilization review reduce unnecessary hospital care and contain costs?Medical Care 1989; 27(6):632–647.

    Article  CAS  PubMed  Google Scholar 

  29. Gotowka TD, Smith RB: Focused psychiatric review: impacts on expense and utilization.Benefits Quarterly 1991; 7(4):73–81.

    CAS  PubMed  Google Scholar 

  30. Rodriguez AR, Maher JJ: Psychiatric case management offers cost, quality control.Business and Health 1986; 3(3):14–17.

    CAS  PubMed  Google Scholar 

  31. Franklin JL, Solovitz B, Mason M, et al.: An evaluation of case management.American Journal of Public Health 1987; 77(6):674–678.

    Article  CAS  PubMed  Google Scholar 

  32. Bond GR, Miller LD, Krumwied RD, et al.: Assertive case management in three CMHCs: a controlled study.Hospital and Community Psychiatry 1988; 39(4):411–418.

    CAS  PubMed  Google Scholar 

  33. Peterson PR: How to make a soft landing.Business and Health 1988; 5(9):18–21.

    CAS  PubMed  Google Scholar 

  34. Anderson DF: How effective is managed mental health care?Business and Health 1989; 7(9):34–35.

    CAS  PubMed  Google Scholar 

  35. Alexander Consulting Group: The impact of the ASSIST program during 1989 at the McDonnell Douglas Helicopter Company. Westport, Conn. 1990; Alexander Consulting Group.

  36. Kuzmicki KV, Penner NR: The American Psychiatric Association’s Psychiatric Case Management Program.Quality Review Bulletin January 1987; 21–25.

  37. Burton WN, Hoy DA, Bonin RL, et al.: Quality and cost-effective management of mental health care.Journal of Occupational Medicine 1989; 31(4):363–367.

    CAS  PubMed  Google Scholar 

  38. Gray BH, Field MJ (eds.):Controlling Costs and Changing Patient Care? The Role of Utilization Management Institute of Medicine. Washington DC: National Academy Press, 1989.

    Google Scholar 

  39. Sharfstein SS, Thistel C, Scott J, et al.: Impact of benefits limits and managed care on discharge plans and outcome: a research design and preliminary results.The Psychiatric Hospital 1990; 21(4):177–182.

    CAS  PubMed  Google Scholar 

  40. Dorwart RA: Managed mental health care: myths and realities in the 1990s.Hospital and Community Psychiatry 1990; 41(10):1087–1091.

    CAS  PubMed  Google Scholar 

  41. Tischler GL: Utilization management and the quality of care.Hospital and Community Psychiatry 1990; 41(10):1099–1102.

    CAS  PubMed  Google Scholar 

  42. American Psychiatric Association Office of Economic Affairs: California ruling expands third parties’ liability. Eco-facts 1990; 4(3):7.

    Google Scholar 

  43. Snyder MA: A case study of state managed care regulation: utilization review laws.Benefits Quarterly 1992; 8(2):16–25.

    CAS  PubMed  Google Scholar 

  44. Koco L: UR firm makes its protocols public.National Underwriter 1991; 95(4):3, 26.

    Google Scholar 

  45. Herrington BS: ‘Time is running out’ to protect mental health benefits.Psychiatric News October 19 1990; 12.

    Google Scholar 

  46. Sederer LI, St. Clair RL: Managed mental health care and the Massachusetts experience.American Journal of Psychiatry 1989; 146(9):1142–1148.

    CAS  PubMed  Google Scholar 

  47. Bryant M: Are rising mental health costs driving you crazy?Business and Health 1990; 9(1):36–43.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Economics, Boston University, 270 Bay State Rd., 02215, Boston, MA

    Dominic Hodgkin Ph.D. (Candidate)

Authors
  1. Dominic Hodgkin Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This study was supported by Grant IR01 MH45089-01A1 from the National Institute of Mental Health.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hodgkin, D. The impact of private utilization management on psychiatric care: A review of the literature. The Journal of Mental Health Administration 19, 143–157 (1992). https://doi.org/10.1007/BF02521315

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02521315

Keywords

Search

Navigation