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Related Experiment Videos

Encouraging third-party coverage of partial hospitals

E B Fink

    Hospital & Community Psychiatry
    |January 1, 1982
    PubMed
    Summary

    Third-party insurers deny coverage for partial hospital programs despite proven effectiveness. Barriers include cost accountability, financial incentives, and consumer interest. Redefining services and developing treatment standards are key to securing coverage.

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    Area of Science:

    • Healthcare Management
    • Health Economics
    • Clinical Services

    Background:

    • Partial hospital programs demonstrate clinical and economic value.
    • Third-party insurers frequently deny coverage for these essential services.
    • Significant barriers impede the integration and reimbursement of partial hospital care.

    Purpose of the Study:

    • To identify barriers to third-party insurance coverage for partial hospital programs.
    • To propose recommendations for overcoming these reimbursement challenges.
    • To advocate for improved access to partial hospitalization services.

    Main Methods:

    • Analysis of clinical, administrative, and fiscal issues.
    • Identification of barriers including cost accountability and financial incentives.
    • Formulation of strategic recommendations for coverage pursuit.

    Main Results:

    • Key barriers to coverage include lack of cost accountability and financial incentives for insurers.
    • Limited consumer interest also presents a challenge.
    • Lack of defined service scope and treatment standards hinders reimbursement.

    Conclusions:

    • Redefining the scope of partial hospital services is crucial.
    • Developing detailed treatment standards is a prerequisite for securing third-party coverage.
    • Addressing identified barriers will facilitate broader access to effective partial hospitalization care.

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