HEALTH MAINTENANCE ORGANIZATIONS, HEALTH-CARE REFORM, AND PERSONS WITH SERIOUS MENTAL-ILLNESS

Implementation of the Clinton Administration's proposed Health Securit y Act could significantly increase the number of seriously mentally il l persons enrolled in health maintenance organizations (HMOs). Studies of the mental health status and outcomes of seriously mentally ill pe rsons treated in HMOs show conflicting findings and provide little gui dance about the likely effect of the Health Security Act on this popul ation. However, implementation of the Health Security Act would be lik ely to influence the treatment of seriously mentally ill persons by al tering the activities of state and local governments in the financing and delivery of care, facilitating the integration of public and priva te services, and encouraging development of additional service capacit y. To clarify HM Os' likely role in providing services to seriously me ntally ill persons under health care reform, more research is needed o n the current service capacity of HMOs, on treatment approaches and ou tcomes in different HMO models, on whether seriously mentally ill pers ons would he likely to choose HMOs from among health plan options, and on whether higher-income HMO enrollees would seek care outside HMO pr ovider networks.