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Characteristics of psychoanalytic patients under a nationalized health plan: DSM-III-R diagnoses, previous treatment, and childhood trauma.

https://arctichealth.org/en/permalink/ahliterature218439
Source
Am J Psychiatry. 1994 Apr;151(4):586-90
Publication Type
Article
Date
Apr-1994
Author
N. Doidge
B. Simon
L A Gillies
R. Ruskin
Author Affiliation
Clarke Institute of Psychiatry, Toronto, Ont., Canada.
Source
Am J Psychiatry. 1994 Apr;151(4):586-90
Date
Apr-1994
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Child
Child Abuse, Sexual - epidemiology
Cluster analysis
Comorbidity
Female
Humans
Insurance, Psychiatric - statistics & numerical data
Life Change Events
Male
Mental Disorders - epidemiology - therapy
National Health Programs - statistics & numerical data
Ontario - epidemiology
Personality Disorders - epidemiology - therapy
Physician's Practice Patterns - statistics & numerical data
Psychoanalysis - statistics & numerical data
Psychoanalytic Therapy - statistics & numerical data
Sex Distribution
Abstract
This article reports the results of a survey to collect data on the characteristics of patients in psychoanalysis under a nationalized health insurance scheme.
A questionnaire, to be answered anonymously, was sent to all 174 accredited psychoanalysts in Ontario, Canada. Part 1 of the questionnaire consisted of 38 questions on the analyst's pattern of practice. Part 2, also to be filled out by the analyst, consisted of 452 questions on the demographic characteristics, childhood traumas, DSM-III-R diagnoses, and indications for psychoanalysis of each of the analyst's patients.
One hundred seventeen analysts responded--a survey response rate of 67%--with data on 580 patients. Fifty-nine percent (N = 344) of patients were women, and 41% (N = 236) were men. Eighty-two percent had attempted other forms of treatment, including briefer forms of psychotherapy and medication, prior to psychoanalysis. During childhood, 23% had had traumatic separations, 23% had been sexually abused, 22% had been physically abused, and 21% had had a parent or sibling die. The mean number of adult psychiatric disorders at the beginning of analysis was four, and the mode was two.
In a nationalized health insurance scheme, the psychoanalytic patients were mostly women, they had high rates of trauma and psychopathology, and they had attempted other forms of briefer treatment before resorting to psychoanalysis.
PubMed ID
8147458 View in PubMed
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Comparative costs and impacts of Canadian and American payment systems for mental health services.

https://arctichealth.org/en/permalink/ahliterature230402
Source
Hosp Community Psychiatry. 1989 Aug;40(8):805-8
Publication Type
Article
Date
Aug-1989
Author
D A Bigelow
B H McFarland
Author Affiliation
Department of Psychiatry, School of Medicine (GH), Oregon Health Sciences University, Portland 97201.
Source
Hosp Community Psychiatry. 1989 Aug;40(8):805-8
Date
Aug-1989
Language
English
Publication Type
Article
Keywords
British Columbia
Documentation
Health Services Accessibility - economics
Humans
Insurance, Psychiatric
Mental Health Services - economics - organization & administration
Oregon
Reimbursement Mechanisms
Abstract
In attempts to contain mental health costs, administrators are increasingly using incentives, competition, and accounting strategies and are creating more complicated financing systems. Yet the costs of these strategies and their impacts on the efficacy and efficiency of mental health services have yet to be studied. The authors compare mental health payment systems in British Columbia and Oregon. In the Canadian system, the patient is isolated from payment, sources of revenue are consolidated at the provincial level, only one payment mechanism per service type is used, health care documentation is oriented more to clinical needs than to reimbursement, and more discretion is delegated to providers. As a result, Canadian overhead costs are substantially less than those in the U.S. Patients have universal access to medical services in the Canadian system, and providers in hospitals, agencies, and individual practices have high incomes with low overhead costs.
PubMed ID
2759569 View in PubMed
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Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario.

https://arctichealth.org/en/permalink/ahliterature190394
Source
Am J Psychiatry. 2002 May;159(5):845-51
Publication Type
Article
Date
May-2002
Author
Mark J Edlund
Philip S Wang
Patricia A Berglund
Stephen J Katz
Elizabeth Lin
Ronald C Kessler
Author Affiliation
UCLA Neuropsychiatric Institute, Los Angeles, CA, USA.
Source
Am J Psychiatry. 2002 May;159(5):845-51
Date
May-2002
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Attitude to Health
Combined Modality Therapy
Epidemiologic Studies
Female
Humans
Income - statistics & numerical data
Insurance, Psychiatric - statistics & numerical data
Male
Medically Uninsured - statistics & numerical data
Mental Disorders - epidemiology - therapy
Middle Aged
Ontario - epidemiology
Patient Dropouts - classification - psychology - statistics & numerical data
Probability
Psychotherapy
Psychotropic Drugs - therapeutic use
United States - epidemiology
Abstract
The authors interviewed individuals treated for self-described mental health problems in the preceding year to examine patterns and predictors associated with dropping out of treatment.
Subjects were drawn from respondents to community epidemiological surveys carried out in representative samples of the United States and Ontario populations. Dropouts were those who had left mental health treatment during the prior year for reasons other than symptom improvement. The surveys also assessed potential dropout correlates: sociodemographic characteristics, attitudes about mental health care, disorder type, provider type, and treatment received.
The proportion of dropouts did not significantly differ between the United States (19.2%) and Ontario (16.9%), nor did the effects of the predictors differ significantly between the two samples. Sociodemographic characteristics associated with treatment dropout included low income, young age, and, in the United States, lacking insurance coverage for mental health treatment. Patient attitudes associated with dropout included viewing mental health treatment as relatively ineffective and embarrassment about seeing a mental health provider. Respondents who received both medication and talk therapy were less likely to drop out than those who received single-modality treatments.
Mental health treatment dropout is a serious problem, especially among patients who have low income, are young, lack insurance, are offered only single-modality treatments, and have negative attitudes about mental health care. Cost-effective interventions targeting these groups are needed to increase the proportion of patients who complete an adequate course of treatment.
PubMed ID
11986140 View in PubMed
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The effects of National Health Insurance on Canadian Psychiatry: the Ontario experience.

https://arctichealth.org/en/permalink/ahliterature250114
Source
Am J Psychiatry. 1977 Mar;134(3):248-52
Publication Type
Article
Date
Mar-1977
Author
B. Liptzin
Source
Am J Psychiatry. 1977 Mar;134(3):248-52
Date
Mar-1977
Language
English
Publication Type
Article
Keywords
Child
Child Health Services
Confidentiality
Costs and Cost Analysis
Delivery of Health Care
Fees, Medical
Financing, Government
Humans
Income
Insurance, Psychiatric
Ontario
Psychiatry
Quality Control
Quality of Health Care
State Medicine
Abstract
After studying psychiatric coverage under national health insurance in Ontario, the author concludes that psychiatric benefits can be provided on the same basis as other medical benefits and that a government system can maintain confidentiality. Costs have been reasonable and in line with the proportion of psychiartists to the total number of physicians, and psychiartists' incomes have increased substantially, even with comparatively low official fees. Despite the existence of NHI, the public mental health system has been maintained in Canada and has been expanded in regard to children's services. There appears to be a continued need for direct public funding of services for certain other groups such as the elderly, chronic patients, ans substance abusers.
PubMed ID
842700 View in PubMed
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Frame disturbances in no-fee psychotherapy.

https://arctichealth.org/en/permalink/ahliterature243622
Source
Int J Psychoanal Psychother. 1982-1983;9:135-46
Publication Type
Article
Author
J. Paris
Source
Int J Psychoanal Psychother. 1982-1983;9:135-46
Language
English
Publication Type
Article
Keywords
Adult
Canada
Fees and Charges
Humans
Insurance, Psychiatric
Male
Patient Discharge
Patient Dropouts - psychology
Professional-Patient Relations
Psychoanalytic Theory
Psychotherapy - economics
Abstract
The frame of psychotherapy shows both universality and social relativity. Since the intrapsychic world is permeable to social reality, the meaning of insurance in psychotherapy depends on context. Experience with Canadian National Health Insurance suggests that when no-fee psychotherapy in normative, it is absorbed in the frame. There are still trouble spots in the Canadian system, particularly the management of missed sessions. Depending on the needs of the patient, charging for missed sessions can disrupt therapy entirely or be constructive for the treatment.
PubMed ID
7152812 View in PubMed
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Mental health: a cause or consequence of injury? A population-based matched cohort study.

https://arctichealth.org/en/permalink/ahliterature169498
Source
BMC Public Health. 2006;6:114
Publication Type
Article
Date
2006
Author
Cate M Cameron
David M Purdie
Erich V Kliewer
Rod J McClure
Author Affiliation
School of Medicine, Griffith University, Meadowbrook, Australia. cate.cameron@griffith.edu.au
Source
BMC Public Health. 2006;6:114
Date
2006
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aftercare - utilization
Comorbidity
Confounding Factors (Epidemiology)
Female
Hospitalization - statistics & numerical data
Hospitals, Psychiatric - utilization
Humans
Insurance, Psychiatric - statistics & numerical data
Male
Manitoba - epidemiology
Mental Disorders - complications - epidemiology
Mental Health Services - utilization
Middle Aged
Retrospective Studies
Risk factors
Trauma Severity Indices
Wounds and Injuries - complications - epidemiology
Abstract
While a number of studies report high prevalence of mental health problems among injured people, the temporal relationship between injury and mental health service use has not been established. This study aimed to quantify this relationship using 10 years of follow-up on a population-based cohort of hospitalised injured adults.
The Manitoba Injury Outcome Study is a retrospective population-based matched cohort study that utilised linked administrative data from Manitoba, Canada, to identify an inception cohort (1988-1991) of hospitalised injured cases (ICD-9-CM 800-995) aged 18-64 years (n = 21,032), which was matched to a non-injured population-based comparison group (n = 21,032). Pre-injury comorbidity and post-injury mental health data were obtained from hospital and physician claims records. Negative Binomial regression was used to estimate adjusted rate ratios (RRs) to measure associations between injury and mental health service use.
Statistically significant differences in the rates of mental health service use were observed between the injured and non-injured, for the pre-injury year and every year of the follow-up period. The injured cohort had 6.56 times the rate of post-injury mental health hospitalisations (95% CI 5.87, 7.34) and 2.65 times the rate of post-injury mental health physician claims (95% CI 2.53, 2.77). Adjusting for comorbidities and pre-existing mental health service use reduced the hospitalisations RR to 3.24 (95% CI 2.92, 3.60) and the physician claims RR to 1.53 (95% CI 1.47, 1.59).
These findings indicate the presence of pre-existing mental health conditions is a potential confounder when investigating injury as a risk factor for subsequent mental health problems. Collaboration with mental health professionals is important for injury prevention and care, with ongoing mental health support being a clearly indicated service need by injured people and their families. Public health policy relating to injury prevention and control needs to consider mental health strategies at the primary, secondary and tertiary level.
Notes
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Cites: J Trauma. 2005 Sep;59(3):639-4616361907
Cites: Am J Public Health. 2000 Sep;90(9):1466-810983210
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Cites: Med Care. 2002 Aug;40(8 Suppl):IV-26-3512187165
Cites: J Trauma. 2002 Oct;53(4):709-1612394871
Cites: Clin Psychol Rev. 2003 Jul;23(4):587-60312788111
Cites: J Burn Care Rehabil. 2003 Sep-Oct;24(5):347-5014501409
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Cites: Spinal Cord. 2004 Sep;42(9):513-2515249928
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Cites: J Nerv Ment Dis. 1993 Aug;181(8):467-748360638
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Cites: Brain Inj. 1999 Feb;13(2):113-2410079956
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Cites: Br J Neurosurg. 2000 Jun;14(3):219-2410912198
PubMed ID
16650287 View in PubMed
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Mental health care use, morbidity, and socioeconomic status in the United States and Ontario.

https://arctichealth.org/en/permalink/ahliterature208851
Source
Inquiry. 1997;34(1):38-49
Publication Type
Article
Date
1997
Author
S J Katz
R C Kessler
R G Frank
P. Leaf
E. Lin
Author Affiliation
Department of Internal Medicine, University of Michigan, Ann Arbor 48109-0376, USA.
Source
Inquiry. 1997;34(1):38-49
Date
1997
Language
English
Publication Type
Article
Keywords
Adult
Ambulatory Care - statistics & numerical data - utilization
Comorbidity
Female
Humans
Insurance Coverage
Insurance, Psychiatric - statistics & numerical data - utilization
Male
Medically Uninsured
Mental Disorders - epidemiology - therapy
Mental Health Services - economics - statistics & numerical data - utilization
Middle Aged
Morbidity
Odds Ratio
Ontario - epidemiology
Random Allocation
Socioeconomic Factors
United States - epidemiology
Abstract
This study focuses on mental health problems and compares the association of demographic and socioeconomic factors to the use of mental health specialty care and general medical care in the United States and the Canadian province, Ontario. It also examines how lack of insurance coverage in the United States and perceived need for care affects differences between the two countries. We employ a cross-sectional study design using the 1990 U.S. National Comorbidity Survey and the 1990 Mental Health Supplement to the Ontario Health Survey. Overall, 8.8% of Americans report one or more visits to the health sector for a mental health problem, compared to 6.9% of Canadians in Ontario. Americans with the highest incomes and no mental morbidity are much more likely to receive services than their Canadian counterparts. By contrast, Americans with the lowest incomes and high morbidity are much less likely to receive services for mental health problems than a similar group of Canadians. These results suggest that universal and comprehensive coverage, as exists in Ontario, does not necessarily lead to increased use of services with low value. However, the greater prevalence of perceived need for care among Americans with higher socioeconomic status and low mental morbidity suggests that the United States should be cautious in drawing lessons from other countries.
PubMed ID
9146506 View in PubMed
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Mental health services rate low priority.

https://arctichealth.org/en/permalink/ahliterature242835
Source
Dimens Health Serv. 1982 Oct;59(10):32
Publication Type
Article
Date
Oct-1982
Author
C C McMaster
Source
Dimens Health Serv. 1982 Oct;59(10):32
Date
Oct-1982
Language
English
Publication Type
Article
Keywords
Canada
Consumer Advocacy
Humans
Insurance, Psychiatric - trends
Mental Health Services - economics
PubMed ID
7173505 View in PubMed
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More lessons, of a different kind: Canadian mental health policy in comparative perspective.

https://arctichealth.org/en/permalink/ahliterature222763
Source
Hosp Community Psychiatry. 1992 Nov;43(11):1083-90
Publication Type
Article
Date
Nov-1992
Author
D A Rochefort
Author Affiliation
Northeastern University, Boston, Massachusetts 02115.
Source
Hosp Community Psychiatry. 1992 Nov;43(11):1083-90
Date
Nov-1992
Language
English
Publication Type
Article
Keywords
Canada
Cost Control - legislation & jurisprudence
Cross-Cultural Comparison
Health Policy - economics - legislation & jurisprudence
Humans
Insurance, Psychiatric - legislation & jurisprudence
Mental Health Services - economics - legislation & jurisprudence
National Health Programs - economics - legislation & jurisprudence
Abstract
Many health policy reformers and researchers in the United States have focused on the Canadian health care system and its lessons for design of a national health care program in the U.S. Yet minimal attention has been given to Canadian mental health policy in this discussion. The author reviews the historical development of mental health services in Canada and discusses five current sources of tension in Canada's mental health care system, many of which are familiar to the American setting: restriction on fee-for-service payments, a two-tiered pattern of care involving provincial mental hospitals and general hospital psychiatric units, shortages of mental health care resources, limited funding of community-based programs, and lack of coordination of care. The author concludes that universal insurance coverage patterned after the Canadian model would ameliorate only some problems faced by mentally ill persons in the United States. Mental health benefits must be structured to ensure the availability and organization of a full spectrum of long-term health care and supportive services.
PubMed ID
1490706 View in PubMed
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National health insurance and private psychiatry.

https://arctichealth.org/en/permalink/ahliterature227542
Source
Health Rep. 1991;3(3):221-7
Publication Type
Article
Date
1991
Author
A. Richman
Source
Health Rep. 1991;3(3):221-7
Date
1991
Language
English
French
Publication Type
Article
Keywords
Canada
Fees, Medical
Health Care Rationing
Health Services Accessibility
Health services needs and demand
Humans
Insurance, Psychiatric
National Health Programs
Private Practice
Psychiatry - economics - manpower
Abstract
From 1972-73 to 1988-89, the number of Canadian psychiatrists doubled. Most psychiatrists are in fee-for-service practice. The median earnings of psychiatrists are close to those of internists. There is lack of psychiatric services available, but not a lack of psychiatrists. The lack of services is due largely to the allocation of psychiatric resources. The maldistribution of psychiatrists is increasing as more settle in urban centres. The U.S. General Medical National Advisory Council recommends that psychiatry spend two thirds of clinical time treating severe illnesses such as psychoses. Before any changes are made to the structure of Canadian psychiatry, more data are needed on patterns of fee-for-service practice, the characteristics of patients, the course and outcome of private psychiatric care, and alternative patterns of practice in which psychiatrists are consultants to family physicians and non-medical therapists.
PubMed ID
1801955 View in PubMed
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15 records – page 1 of 2.