Psychiatrist and nonphysician mental health provider staffing levels in health maintenance organizations. 1998

T H Dial, and C Bergsten, and M G Haviland, and H A Pincus
Department of Psychiatry, Loma Linda University School of Medicine, Calif., USA. tdial@compuserve.com

OBJECTIVE This study attempts to determine the ratio of full-time-equivalent psychiatrists to members and that of nonphysician mental health professionals to psychiatrists in staff and group model health maintenance organizations (HMOs), and to compare the psychiatrist-to-member ratio with previous estimates of the required psychiatrist-to-population ratios in fee-for-service and managed care environments. METHODS The Group Health Association of America (now the American Association of Health Plans) collected data on mental health staffing, enrollments, and other characteristics for 30 staff and group model HMOs. The authors evaluated the number of full-time-equivalent psychiatrists and nonphysician mental health professionals per 100,000 HMO members, and the ratio of full-time-equivalent nonphysician mental health professionals to psychiatrists. RESULTS The overall mean number of full-time-equivalent psychiatrists and nonphysician mental health professionals per 100,000 members in the responding HMOs was 6.8 and 22.9, respectively. The overall mean ratio of nonphysician professionals to psychiatrists was 4.5. The overall number of psychiatrists per 100,000 members is less than half the requirement estimated by the Graduate Medical Education National Advisory Committee in 1980, which assumed a fee-for-service environment, but it is about 40% to 80% greater than that estimated by other studies under the assumption of a managed care environment. CONCLUSIONS Although a practice environment dominated by managed care may not require as high a psychiatrist-to-population ratio as a predominantly fee-for-service environment, it may well support a greater number of psychiatrists than previous studies have suggested.

UI MeSH Term Description Entries
D008605 Mental Health Services Organized services to provide mental health care. Mental Hygiene Services,Health Services, Mental,Services, Mental Health,Services, Mental Hygiene,Health Service, Mental,Hygiene Service, Mental,Hygiene Services, Mental,Mental Health Service,Mental Hygiene Service,Service, Mental Health,Service, Mental Hygiene
D011568 Psychiatric Nursing A specialty concerned with the application of psychiatric principles in caring for the mentally ill. It also includes the nursing care provided the mentally ill patient. Mental Health Nursing,Nursing, Psychiatric,Psychosocial Nursing,Nursing, Mental Health,Nursing, Psychosocial
D011570 Psychiatry The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders.
D011586 Psychology, Clinical The branch of psychology concerned with psychological methods of recognizing and treating behavior disorders. Clinical Psychology
D002321 Career Choice Selection of a type of occupation or profession. Career Choices,Choice, Career,Choices, Career
D006279 Health Maintenance Organizations Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988) Group Health Organizations, Prepaid,HMO,Prepaid Group Health Organizations,Health Maintenance Organization,Organizations, Health Maintenance,Organization, Health Maintenance
D006280 Health Workforce The availability of HEALTH PERSONNEL. It includes the demand and recruitment of both professional and allied health personnel, their present and future supply and distribution, and their assignment and utilization. Health Manpower,Health Occupations Manpower,Manpower, Health,Manpower, Health Occupations,Workforce, Health
D006301 Health Services Needs and Demand Health services required by a population or community as well as the health services that the population or community is able and willing to pay for. Health Services Needs,Needs,Needs and Demand, Health Services,Target Population,Health Services Need,Need, Health Services,Needs, Health Services,Population, Target,Populations, Target,Target Populations
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012947 Social Work The use of community resources, individual case work, or group work to promote the adaptive capacities of individuals in relation to their social and economic environments. It includes social service agencies. Service, Social,Social Intervention,Social Service,Social Service Intervention,Social Work Intervention,Intervention, Social,Intervention, Social Service,Intervention, Social Work,Interventions, Social Work,Service Intervention, Social,Services, Social,Social Interventions,Social Service Interventions,Social Services,Social Work Interventions,Work Intervention, Social

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