by the nature of its business model, health maintenance organization's (HMOs) desire for medical and cost effectiveness of threatening process and treatment goals for clients seeking mental health care. Often, mental health experts, acting under HMO guidelines and fees, find support in ethical corners with an almost impossible decision and lose-lose situations.
In order to address the adverse effects of HMOs on the delivery of mental health services, must know the two basic principles that explain the philosophy of managed care: 1) containing costs and 2) ensuring the quality of care. In order to keep costs, HMOs limit the amount and type of services, track service operated, change the nature of services provided, using cost-effective, but questionably effective treatment guidelines and financial incentives and penalties to influence services, securities and financial intermediaries.
philosophy of cost containment requires a mental health counselor immediately assess the client's problem, to make the diagnosis, treatment, and to set goals - which under normal conditions, you need a lot of sessions to discover the essence of the problem. However, HMOs want the definition and diagnosis is the first one or two sessions.
to cure too quickly diagnosed the problem often comes as a short, short, highly focused interventions that followed the treatment guidelines and protocols, which favor the HMO, but not necessarily the client. Although such standardized treatment can be effective for certain mental health problems, it does not take into account the unique nature of different clients who seek mental zdravlja.Korištenje brief, solution focused therapy is also of concern advisers nadležnosti.Američka Counseling Association Code of Ethics requires counselors to practice within the range of skills and abilities. Although many counselor education programs currently taught brief therapy (also called a solution focused therapy) principles and techniques, not all counselors to practice HMOs have the necessary training, experience, or credentials to use short therapy.
dignity and welfare of clients is primarily the responsibility of consultants and to respect the research base, effective treatment plans that are consistent with the client's needs, abilities and situations, respecting the client's freedom of choice in treatment. However, this responsibility is compromised when the counselor does not have the freedom to plan and implement the necessary treatment he or she must choose between the implementation of appropriate treatment and loss of HMO and fee-or-less implements treatment plans and HMOs prefer to get paid. These guidelines also HMO compromise counselor autonomy in determining what form (s) of intervention are appropriate in accordance with the client's problem, it usurps a consultant clinical assessment and professionalism. In addition, the consultant was forced to spend less time providing psychological services to its customers in order to complete the increased paperwork requirements on behalf of the HMO.
customer care is also compromised by moderate treatment (HMO specified time limits), which calls into question the quality of services received. Time-limited treatment means that only part of treatment provided, and this can lead to premature termination of counseling process (although the client is not resolving the problem they sought help). Unfortunately, as a clinical limitation not only affects the quality of service, but an ethical and legal issues and the advisor may be called to account, if you take the case to court, although the HMO guidelines.
Another worrisome problem is the inability of HMOs introduced to ensure the confidentiality of the process of consultation. Confidentiality is one of the main elements that facilitate consultant-client relationship and allows the client to feel safe and share the most private and intimate aspects of their lives. In addition to confidentiality restrictions imposed by ACA Code of Ethics (breach of confidentiality is permitted in situations where the client may harm himself or others), HMO regulations ask for a comprehensive, personal customer data and detailed reports on their liječenju.Rizik from providing such personal information to a when divided by the HMO, an adviser has little to no control over what happens to them.
HMOs support the medical model of understanding mental health - the customer problem must be a medical term (eg, depression, anxiety), similar to the diagnosis by a physician, to approve mental health services. Questions addressed in marriage counseling or representing the normal component of life are not eligible for a refund. Therefore, the process of setting the correct diagnosis is also influenced by HMOs that will reimburse for certain probleme.Savjetnik faced with an unpleasant and immoral position downcoding upcoding or diagnosis (setting higher or lower than the accurate diagnosis of the issue) to approve more advice or to make sure the client actually receives the necessary treatment for a real problem.
minority but growing view is that cutting out the middle man (HMO) benefits both client and praktičar.Izravna payment option should carefully consider both sides of the practitioners reduce their rates to Incentivize the appeal of direct payments and allow the client to negotiate the prices of services for the most effective treatment outcome. Through the direct payment option, the client can receive more treatment and directly negotiate the conditions that make it or feel comfortable. Third parties should not dictate the treatment protocol when it is in the best interest of the client, and eliminates the freedom of a mental health practitioner must be in favor of his client.