The author describes the utilization review process, utilization
patterns, and service cost of the Mental Health Service of the Health
Insurance Plan of Greater New York (HIP). He finds that a mental health
care delivery system within a health maintenance organization offers the
advantages of sophisticated utilization review procedures, reduced cost per
mental health incident, and a low utilization rate and low cost for
psychiatric hospitalization. However, the HMO's return-to- function
treatment goals may be too limited for the minority of patients who would
benefit only from long-term intensive treatment. He recommends that cost
accounting be based on cost per illness rather than cost per service.
Abstract Teaser