학술논문
Are psychiatrists cost-effective? An analysis of integrated versus split treatment.
Document Type
Academic Journal
Author
Dewan M; Department of Psychiatry, State University of New York Health Sciences Center at Psychiatry, State University of New York Health Sciences Center at Syracuse, 13210, USA. dewanm@vax.cs.hscsyr.edu
Source
Publisher: American Psychiatric Association Country of Publication: United States NLM ID: 0370512 Publication Model: Print Cited Medium: Print ISSN: 0002-953X (Print) Linking ISSN: 0002953X NLM ISO Abbreviation: Am J Psychiatry Subsets: MEDLINE
Subject
Language
English
ISSN
0002-953X
Abstract
Objective: Managed care organizations prefer putatively less expensive split treatment, i.e., a psychopharmacologist plus a non-M.D. psychotherapist. In this study the cost of integrated care by a psychiatrist was compared with split care.
Method: Using 1998 fee schedules of seven large managed care organizations (with 54.3% market share and 67.8 million lives) plus Medicare (37 million people), the author modeled clinical scenarios of psychotherapy alone, medication alone, and combined treatment provided by a psychiatrist or split with a psychologist or social worker.
Results: Brief psychotherapy by a social worker was the least expensive treatment. When treatment required both psychotherapy and medication, combined treatment by a psychiatrist cost about the same or less than split treatment with a social worker psychotherapist; it was usually less expensive than split treatment with a psychologist psychotherapist.
Conclusions: The integrated biopsychosocial model practiced by psychiatry is both theoretically and economically the preferred model when combined treatment is needed.
Method: Using 1998 fee schedules of seven large managed care organizations (with 54.3% market share and 67.8 million lives) plus Medicare (37 million people), the author modeled clinical scenarios of psychotherapy alone, medication alone, and combined treatment provided by a psychiatrist or split with a psychologist or social worker.
Results: Brief psychotherapy by a social worker was the least expensive treatment. When treatment required both psychotherapy and medication, combined treatment by a psychiatrist cost about the same or less than split treatment with a social worker psychotherapist; it was usually less expensive than split treatment with a psychologist psychotherapist.
Conclusions: The integrated biopsychosocial model practiced by psychiatry is both theoretically and economically the preferred model when combined treatment is needed.