Economic Evaluation Methodology
for Family Therapy Outcome Research
DAVID P. MACKINNON
You are the administrative and research director of the Sunnyside Family Therapy
Clinic (SFTC) in a large metropolitan area. The clinic is rather large, with a clini-
cal staff of 40 and an administrative/support staff of 8. You have been having
trouble getting reimbursements from several local managed care operators for
several of your treatment programs. You suspect that the managed care adminis-
trators do not understand or appreciate family therapy as an alternative therapy
Specifically, you have a family violence treatment program that you feel is far
superior to the individual family violence treatment program at rival Darkside
Therapy Clinic (DTC). DTC is about half the size of SFTC in terms of personnel,
clients, and physical premises. You want to approach the local managed care ad-
ministrators with justification for reimbursing your family domestic violence pro-
gram. What are you going to do?
In these times of rising health care costs and increasingly scarce resources, policymakers, insurance companies, employee assistance programs, and individuals are demanding that services be not only effective, but cost-effective as well. The continuing national debate on health care reform stems in part from the overwhelming cost of adequate, effective health care. The health care industry and consumers who pay for treatment are justifiably interested in knowing both whether a prescribed treatment works and whether it is worth the cost.
Mental health care is no different from other health care areas: The field needs to justify its existence. Managed care providers are seeking mental health care services that can prove their effectiveness (Aderman, Bowers, Russell, & Wegmann, 1993). Third-party reimbursers are particularly concerned with cost-effectiveness. Thirdparty payers must know that treatment is both outcome-effective and cost-effective.