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A framework for assessing the effectiveness, efficiency, and equity of behavioral healthcare.
Am J Manag Care. 1999 Jun 25; 5 Spec No:SP25-44.AJ

Abstract

OBJECTIVE

To evaluate the effectiveness, efficiency, and equity of behavioral healthcare and to guide an assessment of the current state of the art of behavioral health-oriented health services research.

STUDY DESIGN

The framework is grounded in previous conceptual work by the authors in defining a prevention- and outcomes-oriented continuum of healthcare and in identifying and integrating the concepts and methods of health services research and policy analysis for assessing healthcare system performance.

PATIENTS AND METHODS

The defining assumptions are that (1) the denominator for behavioral healthcare services must encompass a look at the population, not just the patients, who manifest behavioral health risks; and (2) the delivery system to address these needs must extend beyond acute, treatment-oriented services to include both primary prevention and aftercare services for chronic relapsing conditions.

RESULTS

Current policy and practice in behavioral healthcare reveal the absence of a comprehensive, coordinated continuum of care; substantial variation in policy and financial incentives to encourage such development; and poorly defined or articulated outcome goals and objectives. The current state of the art of research in this area reflects considerable imprecision in conceptualizing and measuring the effectiveness, efficiency, and equity criteria. Further, these 3 criteria have not been examined together in evaluating system performance.

CONCLUSIONS

The first era of behavioral healthcare focused on cost savings in managed care alternatives; the second is focusing on quality and outcomes; a third must consider the issues of equity and access to behavioral healthcare, especially for the most seriously ill and vulnerable, in an increasingly managed care-dominated public and private policy environment.

Authors+Show Affiliations

University of Texas School of Public Health, Houston 77225, USA. laday@utsph.sph.uth.tmc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

10538859

Citation

Aday, L A., et al. "A Framework for Assessing the Effectiveness, Efficiency, and Equity of Behavioral Healthcare." The American Journal of Managed Care, vol. 5 Spec No, 1999, pp. SP25-44.
Aday LA, Begley CE, Lairson DR, et al. A framework for assessing the effectiveness, efficiency, and equity of behavioral healthcare. Am J Manag Care. 1999;5 Spec No:SP25-44.
Aday, L. A., Begley, C. E., Lairson, D. R., Slater, C. H., Richard, A. J., & Montoya, I. D. (1999). A framework for assessing the effectiveness, efficiency, and equity of behavioral healthcare. The American Journal of Managed Care, 5 Spec No, SP25-44.
Aday LA, et al. A Framework for Assessing the Effectiveness, Efficiency, and Equity of Behavioral Healthcare. Am J Manag Care. 1999 Jun 25;5 Spec No:SP25-44. PubMed PMID: 10538859.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A framework for assessing the effectiveness, efficiency, and equity of behavioral healthcare. AU - Aday,L A, AU - Begley,C E, AU - Lairson,D R, AU - Slater,C H, AU - Richard,A J, AU - Montoya,I D, PY - 1999/10/28/pubmed PY - 1999/10/28/medline PY - 1999/10/28/entrez SP - SP25 EP - 44 JF - The American journal of managed care JO - Am J Manag Care VL - 5 Spec No N2 - OBJECTIVE: To evaluate the effectiveness, efficiency, and equity of behavioral healthcare and to guide an assessment of the current state of the art of behavioral health-oriented health services research. STUDY DESIGN: The framework is grounded in previous conceptual work by the authors in defining a prevention- and outcomes-oriented continuum of healthcare and in identifying and integrating the concepts and methods of health services research and policy analysis for assessing healthcare system performance. PATIENTS AND METHODS: The defining assumptions are that (1) the denominator for behavioral healthcare services must encompass a look at the population, not just the patients, who manifest behavioral health risks; and (2) the delivery system to address these needs must extend beyond acute, treatment-oriented services to include both primary prevention and aftercare services for chronic relapsing conditions. RESULTS: Current policy and practice in behavioral healthcare reveal the absence of a comprehensive, coordinated continuum of care; substantial variation in policy and financial incentives to encourage such development; and poorly defined or articulated outcome goals and objectives. The current state of the art of research in this area reflects considerable imprecision in conceptualizing and measuring the effectiveness, efficiency, and equity criteria. Further, these 3 criteria have not been examined together in evaluating system performance. CONCLUSIONS: The first era of behavioral healthcare focused on cost savings in managed care alternatives; the second is focusing on quality and outcomes; a third must consider the issues of equity and access to behavioral healthcare, especially for the most seriously ill and vulnerable, in an increasingly managed care-dominated public and private policy environment. SN - 1088-0224 UR - https://www.unboundmedicine.com/medline/citation/10538859/A_framework_for_assessing_the_effectiveness_efficiency_and_equity_of_behavioral_healthcare_ L2 - https://www.ajmc.com/pubMed.php?pii=1332 DB - PRIME DP - Unbound Medicine ER -