Frustrations with the mental health medical system in the US
1. it is a nighmare as a family member
2. It is staggeringly expensive: over $1,000 per day for group therapy, 3 hots and a cot.
3. The incentives are perverse: the longer the patient is sick the more money the facility makes
4. The plot line in Netflix's Ozark is chilling: the heroin crime family launders money by creating treatment facilities
5. Balance billing is used: when you sign a contract they all have a clause that you can be "balance billed" for the remainder of whatever they come up with
6. All facilities will verbally tell you that they "never balance bill" and will accept whatever you will pay in addition to the insurance but will refuse to put it in writing. And then also balance bill!
7. HIPAA laws prevent family members from getting any information unless there are signed waivers
8. Perverse incentives part 2: In most businesses, the person that pays is the customer and the desired outcome (a nice haircut) is the product.
In heath care the insurance company is usually the primary payer and they have incentives to pay as little as possible. The "product" that gets paid for is treatment stays, not results. The patient is the raw material that lets the facility make the payments possible. The facility want to maximize time in facility. The insurance company wants to minimize this.
9. Perverse incentives part 3: the facility has a financial disincentive to resolve problems and will stonewall communication with the family members to delay resolution
10. The type of things that might actually help are difficult to execute, hard to make money on and not popular politically
Mental health problems sometimes need long care windows but people should be taught to compartmentalize and "close the book" on their past traumas instead of re-opening the wounds forever in therapy. People need productive activities and jobs in their lives to feel useful and get satisfaction. Longer term care facilities with these goals of getting people out of therapy on a 6 month to 1 year time line would be beneficial but due to stigma, NIMBY and other issues these proposals are not politically popular.
No comments.