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HealthyCal.org covers public health policy

A NEW WINDOW INTO THE DISCUSSION ON HEALTH CARE POLICY
by Dan Weintraub

After more than 25 years covering public policy and politics for California newspapers, Dan Weintraub begins a new online journalism initiative that promises to report on California's government and its communities in new ways.

HealthyCal.org, a nonprofit web site I'm creating with initial funding from the California Endowment, will cover public health policy from inside the Capitol and from communities across California. The goal is to connect the two in a conversation that will inform both.

American Medical Schools Gear Up to Meet Increasing Demands

Nearly two dozen medical schools that have recently opened or might open across the country, the most at any time since the 1960s and '70s.

These new medical schools are seeking to address an imbalance in American medicine that has been growing for a quarter century.


Many bright students were fleeing to offshore medical schools, or giving up hope entirely, when they could not get into domestic schools. 

In a weird aberration of "outsourcing", the medical field was outsourcing medical education to foreign countries, and then hiring foreign nationals to work in our American healthcare system, presumably at lower rates and longer hours.

During the 1980s and '90s only one new medical school was established.

"Huge numbers of qualified American kids were not getting into American medical schools or going abroad to study," Dr. Lawrence G. Smith, dean of the proposed Hofstra University School of Medicine, in Hempstead, N.Y., which is not yet recruiting students, said last week. "I think it was a kind of wake-up call."

The proliferation of new schools is also a market response to a rare convergence of forces:

  • a growing population;
  • the aging of the health-conscious baby-boom generation;
  • the impending retirement of, by some counts, as many as a third of current doctors;
  • the expectation that, the present political climate notwithstanding, changes in health care policy will eventually bring a tide of newly insured patients into the American health care system.

Colleges serve a "Gatekeeping Function" as well as education of new practitioners.  By carefully limiting the number of trained professionals, those with established careers have less competition -- and that can be important to personal care services that must maintain a full staff even when they have a light load of patients.  Under-staffing also causes long delays in getting an appointment, and has healthcare consequences when care is delayed.

If all the schools being proposed actually opened, they would amount to an 18 percent increase in the 131 medical schools across the country.

Read more at the REFERENCE SOURCE:  New York Times

Protect Patients' Genetic Information

In combination with the new penalties for violations of the HIPAA Privacy Rule, a use or disclosure of genetic information in violation of the HIPAA Privacy Rule could result in a fine of $100 to $50,000 or more for each violation.

The interim final rule will help ensure that genetic information is not used adversely in determining health care coverage and will encourage more individuals to participate in genetic testing, which can help better identify and prevent certain illnesses.

"Echoing the late Senator Ted Kennedy, our efforts to protect Americans undergoing genetic testing from having the results of that testing used against them by their insurance companies is one of the 'first major new civil rights' of the new century," said HHS Secretary Kathleen Sebelius.

Consumer confidence in genetic testing can now grow and help researchers get a better handle on the genetic basis of diseases. Genetic testing will encourage the early diagnosis and treatment of certain diseases while allowing scientists to develop new medicines, treatments, and therapies.

The interim final rule with request for comments and the notice of proposed rulemaking implement Title I of the Genetic Information Nondiscrimination Act of 2008 (GINA). Under GINA, and the interim final rule, group health plans and issuers in the group market cannot:

  • increase premiums for the group based on the results of one enrollee's genetic information;
  • deny enrollment; impose pre-existing condition exclusions;
  • or do other forms of underwriting based on genetic information.
  • In the individual health insurance market, GINA prohibits issuers from using genetic information to deny coverage, raise premiums, or impose pre-existing condition exclusions.
  • Group health plans and health insurance issuers in both the group and individual markets cannot request, require or buy genetic information for underwriting purposes or prior to and in connection with enrollment.
  • Plans and issuers are generally prohibited from asking individuals or family members to undergo a genetic test.

"Today's genetic technologies yield data that are vital to helping Americans make personal, medical decisions. It is essential that we protect such information and ensure it is not misused by health plans or insurers," said Labor Secretary Hilda L. Solis. "The rules issued today protect individuals against the unwarranted use of information related to their personal health because no one should have to fear that disclosure of their medical data will put their job or health coverage at risk."

Additionally, HHS, through its Office for Civil Rights (OCR), issued a notice of proposed rulemaking with a 60-day comment period, to propose changes to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to prohibit health plans from using or disclosing genetic information for underwriting purposes.

Please visit http://edocket.access.gpo.gov/2009/pdf/E9-22504.pdf to view the new regulations and www.dol.gov/ebsa for more information about them. For additional information on the OCR notice of proposed rulemaking, please visit: www.hhs.gov/ocr/privacy.

Tips to Reduce Medical Identity Theft

These new tips and information can help seniors and Medicare beneficiaries deter, detect and defend against Medical identity theft.

Medical identity theft occurs when someone steals a patient's personal information, such as his or her name and Medicare number, and uses the information to obtain medical care, to buy drugs or supplies, or to fraudulently bill Medicare using that patient's stolen identity.

New tips were produced by the HHS Office of the Inspector General (OIG)
and are available now at
www.StopMedicareFraud.gov and
www.oig.hhs.gov/fraud/idtheft.


"When criminals steal from Medicare, they are stealing from all of us," said Secretary Sebelius. "Preventing medical identify theft is an important part of our work to stop Medicare fraud, and these tools will give seniors important information about how to deter, detect and defend against ID theft and fraud."

The Department of Justice (DOJ), in collaboration with the Department of Health and Human Services (HHS), will continue to protect the integrity of the nation's public health programs and vigorously pursue those who seek to take advantage of our most vulnerable citizens.

"Medical identity theft can disrupt your life, damage your credit rating, and threaten your health if inaccurate information ends up in your medical records," added HHS Inspector General Daniel R. Levinson.

OIG's agents frequently uncover fraud schemes that involve the sale and use of stolen Medicare identification numbers. 


  • Medicare beneficiaries are reminded to beware of offers of free medical equipment, services, or goods in exchange for their Medicare numbers. 

  • Beneficiaries are also encouraged to regularly review their Medicare Summary Notices, Explanations of Benefits statements, and medical bills for suspicious charges and to report suspected problems.

The effort to help prevent medical identity theft is one part of the Obama Administration's work to crack down on Medicare fraud. In May, Attorney General Eric Holder and Secretary Sebelius announced the creation of a new interagency effort, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), to combat Medicare fraud.  

Teams that have been successfully fighting fraud in South Florida, Los Angeles, Detroit and Houston.  Established in 2007, these teams have a proven record of success using data analysis techniques and community policing to identify, investigate and prosecute on-going fraud.

The Centers for Medicare & Medicaid Services (CMS) has undertaken other steps to fight fraud and protect beneficiaries who buy durable medical equipment or rely on home health services.

  • On October 1, all durable medical equipment suppliers across the nation, except for pharmacies, must be certified by Medicare, a requirement that assures beneficiaries that their suppliers are valid businesses and meet Medicare's financial and quality standards.

Senior Medicare Patrol programs

The SMP programs are funded by HHS' Administration on Aging and help Medicare and Medicaid beneficiaries prevent, detect, and report health care fraud. Because this work often requires face-to-face contact to be most effective, SMPs nationwide recruit and train nearly 5,000 volunteers every year to help in this effort. Most SMP volunteers are both retired and Medicare beneficiaries and thus well-positioned to assist their peers.

To learn more about stopping Medicare fraud, visit www.StopMedicareFraud.gov. To report suspected Medicare fraud call the Inspector General's toll-free Hotline at 800-447-8477 (800-HHS-TIPS). The toll-free TTY number is 800-377-4950.

Cost of Care for Diabetes and Health Insurance Realities

HHS Secretary Kathleen Sebelius released a new report, Preventing and Treating Diabetes: Health Insurance Reform and Diabetes in America.

"Americans with diabetes are suffering in our current health care system," Secretary Sebelius said. "Health insurance reform will help ensure these Americans can get the prescription drugs and supplies they need and bring down premiums so all Americans can have high-quality, affordable health insurance."

As affordable treatment remains inaccessible to many Americans suffering from chronic diseases, people with diabetes shoulder some of the nation's highest health care expenses.


Annual health care expenses for a diabetic topped $11,477 in 2007.


The report notes:

  • One in six individuals with diabetes report avoiding or delaying needed medical care because of cost. A box of 100 test strips for blood sugar monitors can cost up to $60 while the price of a vial of insulin can range from $30 to $70, mainly because generic brands are not manufactured in the United States.
  • A study showed that 80 percent of people with diabetes went uninsured after having lost coverage due to health insurance transitions triggered by job change or layoff, a move, divorce, graduation from college, or a change in income or health status.
  • If all states improved diabetes control to the level of the top four best performing states, at least 39,000 fewer patients would have been admitted for uncontrolled diabetes in 2004, potentially saving $216.7 million.
  • Fourteen percent of American Indians, 12 percent of African Americans, and 10 percent of Hispanics have type 2 diabetes. These rates of diabetes are greater than in the non-Hispanic White population, which has a rate of only 7 percent.

The report outlines the ways health insurance reform will lower costs and improve access to quality health care services for Americans with diabetes. Health insurance reform will lower health care costs for people with diabetes by capping annual out-of-pocket expenses, eliminate discrimination for pre-existing conditions and health status, create a health insurance exchange so families can shop for suitable plans, provide coverage for preventive screenings, and reduce health disparities so that all Americans can have access to quality, affordable health care.

To learn more about how health insurance reform will help Americans with diabetes and view the complete report, visit www.HealthReform.gov.

The Dartmouth Atlas of Health Care Costs

Having just tried to find more cost effective health insurance and long term care insurance, I can tell you how frustrating it is to get good data.  We live in Los Angeles and one would surmise that a large city is more expensive than smaller communities -- but the long term insurance rep said it was less expensive.  

So where is the real data?  I found it!  The Dartmouth Atlas of Health Care!  And believe me,  location matters!

For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide comprehensive information and analysis about national, regional, and local markets, as well as individual hospitals and their affiliated physicians.

Look up your region on this handy interactive map: 


This interactive US Atlas of Health Care shows you various information by local areas... the best, the growth, by hospital referral region.

As you can see, the Los Angeles region has a bit of a difference in prices and cost increases than counties north and south of it.  Hmmmm....

The cost of providing health care to seniors is rising more than twice as fast in Dallas as in San Diego, and Medicare now spends nearly three times more to care for its enrollees in Miami than it does in Honolulu.
This illustrates how huge inefficiencies in the U.S. health care system are hamstringing the nation's ability to expand access to care, according to a new analysis of Medicare spending by researchers of the Dartmouth Atlas Project published in February 2009 in the New England Journal of Medicine.

Nationally, Medicare spent an average of $8,304 per enrollee in 2006, and national spending grew at a rate of 3.5 percent annually from 1992 to 2006. Among states, New York was tops in spending per enrollee, at $9,564. Hawaii was lowest, at $5,311.

Where Medicare spending per enrollee grew at an annual rate of 5 percent in Miami, the rate was less than half, at 2.4 percent, in San Francisco. Medicare spent $16,351 per enrollee in Miami in 2006, almost twice the spending of $8,331 in San Francisco.

The researchers project that, at current spending rates, Medicare will be $660 billion in the red by 2023. But by reducing the annual growth in per capita spending from 3.5 percent, the national average, to 2.4 percent, the rate in San Francisco, Medicare could save $1.42 trillion and turn the deficit into a healthy surplus.

Small Differences Make a Huge Savings

"The good news is that small differences, because of compounding, can make an enormous difference for the long-term solvency of Medicare and our ability to expand coverage for the uninsured," said co-author Jonathan Skinner, Ph. D., the John Sloan Dickey Third Century Chair of Economics at Dartmouth College.

The authors call on physicians to lead an effort to reform how the U.S. delivers and pays for health care to bring spending under control.

Systems of Quality Care

They write: "Payment systems could then shift from purely volume-based payments to systems ... that foster accountability for the overall costs and quality of care, allowing physicians to align their work more closely with the values that brought them to health care. "

"This work demonstrates why health reformers should work to realign private and public payment schemes to benefit quality performance over the volume of services," said Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation. "Clinicians who successfully provide high quality care and slow spending growth should be rewarded, not penalized."

About the Dartmouth Atlas Project
For more than 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide comprehensive information and analysis about national, regional, and local markets, as well as individual hospitals and their affiliated physicians. These reports, used by policymakers, the media, health care analysts and others, have radically changed our understanding of the efficiency and effectiveness of our health care system.

About The Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful, and timely change. For more than 30 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves.

Depression Care Research Results

Depression often coexists with other long-term health problems, presenting additional complexities. About 60 percent of depressed outpatients have at least one other chronic medical condition as well, such as a heart problem, high blood pressure, or diabetes.

The US Department of Health & Human Services, through the Agency for Healthcare Research and Quality  has funded research to track effective care of depression. 

Heart Attacks and Depression

Research results have shown that patients with a history of heart attacks have 1.8 times more depressive spells in a year and more persistent symptoms than depressed patients without a history of heart attacks.

Chronic Conditions and Depression in Older Persons

The challenge of treating depression as one of multiple chronic conditions is especially an issue in older persons. AHRQ research comparing elderly patients with and without depression in a primary care clinic found that the depressed patients had:

  • Nearly $200 more in annual diagnostic test costs.
  • Almost 1.5 more ambulatory care visits per year.
  • Over 12 percent more annual visits to the emergency department.
  • Five percent more hospitalizations each year.

To reduce the cost of care and improve outcomes for older persons with depression, coexisting psychiatric and medical illnesses must be targeted for treatment.

Best Care Mental Health Specialists or Medical Care Providers?

The organization of care can affect care delivery for depression. One AHRQ-sponsored study showed that shifting patients away from mental health specialists to general medical providers (as is the practice in some managed care arrangements) may lead to fewer improvements in patient functioning but costs two to three times less.

Other AHRQ-funded research on the effects of changes in health care payment and delivery found that after switching to a prepaid plan, the health status of outpatients with depression did not appear to suffer although they were 12 percent less likely to use antidepressants and made 35 to 40 percent fewer visits to their mental health care providers.

Even where there is substantial agreement about how treatment for depression can be improved, changes to everyday practice have been slow. Past efforts by managed care organizations to improve compliance with guidelines for improving diagnosis and treatment of depression have met with only modest success.

Two AHRQ studies investigating academic detailing and continuous quality improvement interventions in managed care organizations concluded that these approaches were only mildly effective in improving clinicians' adherence to the recommended guidelines for care. However, promising early results from a current study evaluating ways to increase use of antidepressants and psychotherapy in managed primary care practice suggest that depressed patients in the intervention groups were more likely to receive these interventions and exhibit better outcomes.

The National Guideline Clearinghouseâ„¢ (NGC) sponsored by AHRQ in partnership with the American Medical Association and the American Association of Health Plans, allows physicians and other Internet users to assess and compare guidelines online at http://www.guideline.gov. The NGC is being used by Georgetown University Medical Center's Mood Disorder Program in the development of clinical practice guidelines on depression for primary care physicians in managed care settings.

How to Choose Health Insurance at Work

Dr. Carolyn Clancey is the director of the US Agency for Healthcare Research and Quality.

Here's her advice in how to research and consider the various insurance options that might be available to you at your place of work.  Many of these options also apply if you are purchasing insurance on your own.

Many of the common health insurance plans today offer several choices for coverage, based on factors including cost, flexibility and how much of a role you want to play in managing and paying for your own health care. These include:

  • Preferred provider organizations (PPOs). These plans contract with doctors, hospitals, and other providers but typically do not manage your care. PPOs allow you to see providers outside the network, but you will pay more for your care if you do. These are the most common work-based health plans.
  • Health maintenance organizations (HMOs). Many of these plans focus on preventing diseases and staying healthy. If you join an HMO, you typically must receive all your care from network providers, except in medical emergencies. When you join, you pick a primary care doctor to manage your care. HMOs usually have copayments rather than deductibles or co-insurance.
  • Point-of-service organizations (POS). These plans are a combination of a PPO and an HMO. POS plans have a primary care doctor who manages your care but allow you to seek care from doctors and hospitals that are not part of the plan. You pay more for seeking care out of network, however.
  • Consumer-directed health plans. These newer health plans give  you more control over your own health care, both in choosing the care you receive and paying for it. They often require you to pay a substantial deductible (often $2,000 or more) before coverage starts, and are combined with a personal health savings account or another similar product that allows you to pay for care with pre-tax money.    

Picking a Plan that Works for You

Health insurance can protect you from hefty medical expenses that can easily bankrupt you if an accident or illness strikes. It also lets you pay for access to quality and timely care.

That's why I urge you to read the materials you get during open enrollment season and ask questions. Understanding how your plan works, learning what it does and doesn't cover, and considering the quality of care a plan provides are good ways to choose a plan.

My agency has developed a survey that provides information on consumers' experiences with health plans. The data are collected by different organizations, including the Federal Employees Health Benefits Program and Medicare. Some health plans also collect data and provide it to consumers. You should check to see if your plan provides this information.

To get the best plan at the right price to fit your needs, consider the following:

  • Avoid basing your decision only on the premium. Lower premiums typically mean care comes with higher out-of-pocket costs through deductibles, coinsurance, or copayments. If you're young and healthy, low premiums may be a good fit, but if you have a health condition or are older, it may not be. Review all potential costs before choosing your health plan.
  • Understand what a plan covers. Read the materials you receive with the following questions in mind: What type of doctor visits, surgeries, and hospital care are covered? Is there a drug benefit? If so, how much does it cover and what will it cost you? Are dental and eye care covered? Are there limits on what you pay or what the plan will pay for?
  • Review last year's coverage and care costs. Determine if it was a typical year, what your out-of-pocket costs were, and if it was a good plan for you after all.
  • Find out if your doctor, hospitals, and other providers are in your health plan's network. Decide if you are willing to see other providers, and if you aren't how much it will cost you to go out of the plan's network for care?
  • Look for ways to save money under the plan. Check to see if you can get cheaper prescription drugs if you order them by mail. If you have diabetes or another chronic illness, find out if the plan lowers copayments on medicines to keep your condition in check. Some plans even offer cash or incentives for you to get checkups or join disease management programs.

Picking the right health plan takes some time and effort. Even if you don't have a choice of plans, you need to know how your plan works. Asking questions and checking out your options isn't only good for your health, it can be good for your wallet too.


Read more columns by Dr. Clancey at the US Agency for Healthcare Research and Quality


Opinions About Politics Affect Health Care Choices

Health underlies everything we do.  Not "health care" but health. 

Our well being.  Think safety and joy and comfort food.

Our environment.  Remember Love Canal?

Our behaviors.  Think "exercise".

Our food and exercise and social connections.  Our community resiliency and survival network.
But politics and economics soon enter the health equation.

Here's a health idea that Democrats and Republicans agree on: when given information on the genetic factors that cause diabetes, both parties equally supported public health policies to prevent the disease.

But a study designed by the University of Michigan showed Republicans were less supportive of such policies after reading news reports that people with diabetes got their illness because of social or economic factors in which they live, such as lack of neighborhood grocery stores or safe places to exercise. The social factors increased Democrats' support.

"When people are given the same information they can come away with very different opinions," says Sarah E. Gollust, Ph.D., a Robert Wood Johnson Foundation Health and Society Scholar at the University of Pennsylvania who worked on the study during her doctoral work at U-M.

Increasing public awareness of social factors that impact health may not uniformly increase public support for action because some groups simply do not believe they are credible, authors write.

Social Values Influence Policy...surprised?

"Policymakers and journalists should be aware that social values influence people's opinions about health policy, and certain messages in the media might trigger these values," she says.

The findings contribute to evidence that Americans' opinions about health policy are polarized by political party lines, according to the study.

Gollust designed the study with Paula Lantz, Ph.D., a social epidemiologist and chair of the Department of Health Management and Policy at the U-M School of Public Health and Peter A. Ubel, M.D., professor of internal medicine at the University of Michigan and director of the U-M Center for Behavioral and Decision Sciences in Medicine.

Diabetes News and Policy Research

Study participants viewed news articles about type 2 diabetes on the Internet and then answered questions about their opinions on health policy and their attitudes about people with diabetes.

When each viewed an article on the links between social and neighborhood factors and diabetes, 32 percent of Democrats agreed with social factors' role on health compared to 16 percent of Republicans.

Polarizing Information

"If you are more liberally minded the 'neighborhood explanation' can be motivating, but for people who are more conservative politically, that message can backfire and make them even less interested," says Ubel. "The same information can polarize people."

Diabetes was merely used as an example of a common health issue.

Social and Economic Factors ... and Health

While type 2 diabetes is associated with health behaviors, such as poor diet, lack of physical activity and obesity, these behavioral factors can be influenced by social and economic factors such as living in an unhealthy neighborhood.

Genetic Factors... and Health

Scientists have also identified numerous genetic variants that increase susceptibility to type 2 diabetes.

Non-medical Strategies for Health Care

So why focus on social factors? The goal of framing health matters according to social factors is increasingly used to shift attention to non-medical strategies to improve health. The media also commonly discuss the prevalence of social factors when describing health issues, but few studies have been devoted to whether it shifts public opinion.

Messages in the Media

"The problem is these messages aren't going to have the same effect on all people," Ubel says.

The authors do not suggest that news media avoid reporting on social factors. Rather, advocates who want to mobilize the public to support public health policies might consider disseminating information to the media about both social factors and individual behavioral causes to avoid triggering resistance. 

Messaging Options

  • Social factors
  • Individual behavioral causes
  • Physical science
  • Economic data

Tailored Messages for Audiences?

Isn't tailoring messages close to manipulation?  Writers and message makers all have to pick and choose what is included and excluded from our final message products ... but blatant manipulation to affect advocacy goals is not in our shared best interest. 

"Advocacy groups need to be very careful in thinking about who their audience is and what framing will work best for that audience," Ubel says. "Media should do a richer job of helping people understand each of these different causes."

Authors: Sarah E. Gollust, Ph.D., Paula M. Lantz, Ph.D., and Peter A. Ubel, M.D.

Citation: American Journal of Public Health, Vol. 99, No. 12, December 2009

Funding: Robert Wood Johnson Foundation Health and Society Scholars Program at the University of Michigan and at the University of Pennsylvania, the U-M Center for Behavioral and Decision Sciences in Medicine, and the University of Michigan Rackham Predoctoral Fellowship.

Resources:
U-M Center for Behavioral and Decision Sciences
http://www.cbdsm.org/

U-M School of Public Health
Department of Health Management and Policy
http://www.sph.umich.edu/hmp/

Source:  Newswise, Inc.

Psychological Science in the Public Interest

The prevalence of mental health disorders in this country has nearly doubled in the past 20 years.

Q: Who is treating all of these patients?

A: Clinical psychologists and therapists are charged with the task, but many are falling short by using methods that are out of date and lack scientific rigor.

This is in part because many of the training programs -- especially some Doctorate of Psychology (PsyD) programs and for-profit training centers -- are not grounded in science.

A new report in Psychological Science in the Public Interest, a journal of the Association for Psychological Science, by a panel of distinguished clinical scientists -- Timothy Baker (University of Wisconsin-Madison), Richard McFall (Indiana University), and Varda Shoham (University of Arizona) - calls for the reform of clinical psychology training programs and appeals for a new accreditation system to ensure that mental health clinicians are trained to use the most effective and current research to treat their patients.

There are multiple practices in clinical psychology that are grounded in science and proven to work, but in the absence of standardized science-based training, those treatments go unused.

Cognitive-behavioral Therapy (CBT)

For example, cognitive-behavioral therapy (CBT) has been shown to be the most effective treatment for PTSD and has the fewest side-effects, yet many psychologists do not use this method.

Baker and colleagues cite one study in which only 30 percent of psychologists were trained to perform CBT for PTSD and only half of those psychologists elected to use it.

That means that six of every seven sufferers were not getting the best care available from their clinicians.

Furthermore, CBT shows both long-term and immediate benefits as a treatment for PTSD; whereas medications such as Paxil have shown 25 to 50 percent relapse rates.


Escalating cost of mental health care treatment

The report suggests that the escalating cost of mental health care treatment has reduced the use of psychological treatments and shifted care to general health care facilities.

The authors also stress the importance of coupling psychosocial interventions with medicine because many behavioral therapies have been shown to reduce costs and provide longer term benefits for the client.

Baker and colleagues conclude that a new accreditation system is the key to reforming training in clinical psychology. This new system is already under development: the Psychological Clinical Science Accreditation System (PCSAS www.pcsas.org).

For more information, a copy of this report or to arrange an interview with the authors please contact Kevin Lyn Sisson at 202.293.9300 or ksisson@psychologicalscience.org.

Timothy Baker is Professor of Medicine in the University of Wisconsin School of Medicine and Public Health. Richard McFall is Professor Emeritus in the Department of Psychological and Brain Sciences at Indiana University-Bloomington. Varda Shoham is Professor of Psychology at the University of Arizona..

Psychological Science in the Public Interest provides definitive assessments of topics where psychological science has the potential to inform and improve the well-being of society.

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