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Unformatted text preview: PSYCHIATRIC SERVICES ♦ ps.psychiatryonline.org ♦ March 2007 Vol. 58 No. 3 300 Consumer-directed care, a pay- ment system designed to make patients aware of the costs of care, requires treatment seekers to be active participants in their health care. Core components of consumer-directed care, such as higher deductibles and increased decision-making responsibilities, might preclude its easy transla- tion from medical to behavioral health care. Aspects of behav- ioral disorders will force providers, insurers, and patients to compensate for unique barri- ers to increasing self-care, such as stigma, neuropsychological complications, and poor self-effi- cacy. This column describes im- portant components of con- sumer-directed care and the unique barriers that behavioral health care creates for those components. Possible best prac- tices are suggested for surmount- ing those barriers. ( Psychiatric Services 58:300–302, 2007) H ealth care in the United States seems to be heading toward change, as scholars, policy makers, and members of the health care in- dustry propose to implement con- sumer-directed care, a payment sys- tem designed to make patients aware of the costs of care. Because this transformation likely will include be- havioral health care, it is important for proponents of consumer-directed care to consider the unique charac- teristics of behavioral health care that may act as barriers to the implemen- tation of consumer-directed care. These barriers also need to be taken into account in developing, within consumer-directed care, best prac- tices related to behavioral health care. Consumer-directed care is de- signed to contain health care costs through high deductibles to constrain the use of services; consumer choice of providers, along with treatments based on effectiveness and cost; and the increased use of self-care (1). [A bibliography is available in an online supplement to this column at ps.psy chiatryonline.org] In this column we describe how these three principal components of consumer-directed care—high deductibles, consumer choice, and self-care—could generate unintended negative consequences for consumers’ health and the cost of care. We suggest strategies to adapt consumer-directed care to the com- plicating factors of behavioral health care. High deductibles In managed care, consumers make small copayments that do not vary with the actual cost of different treat- ments. Proponents of consumer-di- rected care argue that this payment system causes unrestrained use of health care services because it insu- lates consumers from the true cost of treatment and provides no disincen- tive for seeking unnecessary, poten- tially expensive care. To minimize “overuse” of health care, proponents of consumer-directed care recom- mend implementing a high de- ductible (the amount of out-of-pock- et money that plan members must spend for care) (2). The rationale is that paying out of pocket should raise consumers’ awareness of health care...
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- Health Affairs, psychiatric services, behavioral health care, Medscape Psychiatry and Mental Health