| With the implementation of managed health care, consumers and clinicians have been faced with an increased bureaucracy, as well as potential limitations to covered mental health services. Mental health clinicians in independent practice have responded to managed care by not participating in HMOs or by not accepting HMO patients. Previous research has focused on the impact managed care has on clinical mental health care practice, yet there is a lack of academic research identifying what factors influence these mental health clinicians to participate or not in HMO networks.; In response, this research examined independent mental health providers' participation in HMOs in South Florida. The study focused on two research questions: (a) Why are mental health practitioners participating or not in HMOs, and (b) why are these practitioners accepting or not HMO patients. Using a cross-sectional survey, 827 independent practitioners in South Florida received a mail survey instrument. Regression analysis and ANOVA of the 418 responses showed that seven factors were significant in influencing participation: level of HMO reimbursement, benefits, utilization management, time required to collect HMO reimbursement, ethical dilemmas, profession, and county. Four factors were significant in influencing acceptance of HMO patients: ethical dilemma, years of clinical experience, time required to collect HMO reimbursement, and the clinician's education level.; These results indicate a need to examine the relationship between treatment outcomes and the clinician's education level and clinical experience. Further insurance regulation should require HMOs to list only clinicians who accept HMO patients.; Finally, the results of this study confirm the need for a better working relationship between HMOs and mental health providers. Research aimed at improving this relationship should focus on addressing ethical concerns, time considerations on getting paid, reimbursement levels, and utilization review processes. All stakeholders would benefit from an improved relationship. |
