Does managed care affect the diffusion of psychotropic medications?
Does managed care affect the diffusion of psychotropic medications?
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DOI：
10.1002/hec.1723
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发表时间：
2012-04-01
期刊：
影响因子：
2.1
通讯作者：
Domino, Marisa E.
中科院分区：
文献类型：
--
作者：
Domino, Marisa E.
治疗许多精神疾病的新技术在各州的扩散率方面表现出很大的异质性。在本文中，我调查管理式医疗渗透水平的变化是否与1991年至2005年期间，在按服务收费的医疗补助计划中，三种新型精神药物在州一级扩散的变化相关。三种不同类型的管理式医疗计划进行检查：资本管理式医疗，任何类型的管理式医疗和行为健康创业。一个四阶多项式固定效应回归模型是用来模拟新的抗抑郁药和抗精神病药物控制随时间变化的状态特征的扩散路径。实质性的差异被发现在扩散路径的管理医疗使用的程度，在每个国家的医疗补助计划。最大的影响是通过资本化管理医疗计划的溢出效应;资本化管理医疗更大的州有更大的新精神药物的初始份额。分割和所有类型的管理式护理相结合的扩散路径的影响是适度的。版权所有（c）2011约翰威利父子有限公司
Newer technologies to treat many mental illnesses have shown substantial heterogeneity in diffusion rates across states. In this paper, I investigate whether variation in the level of managed care penetration is associated with changes in state-level diffusion of three newer classes of psychotropic medications in fee-for-service Medicaid programs from 1991 to 2005. Three different types of managed care programs are examined: capitated managed care, any type of managed care and behavioral health carve-outs. A fourth-order polynomial fixed effect regression model is used to model the diffusion path of newer antidepressant and antipsychotic medications controlling for time-varying state characteristics. Substantial differences are found in the diffusion paths by the degree of managed care use in each state Medicaid program. The largest effect is seen through spillover effects of capitated managed care programs; states with greater capitated managed care have greater initial shares of newer psychotropic medications. The influence of carve-outs and of all types of managed care combined on the diffusion path was modest. Copyright (c) 2011 John Wiley & Sons, Ltd.