DEVELOPMENT OF CASE RATES FOR SUBSTANCE ABUSERS

药物滥用者案件发生率的发展

• 批准号: 6378770
• 负责人: CHRISTOPHER P TOMPKINS
• 金额: $ 25.37万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-01 至 2003-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6378770
• 关键词: Medicare /Medicaid; behavioral /social science research tag; clinical research; drug abuse therapy; health care cost /financing; health care model; health care policy; health care service utilization; health services research tag; human data

This study will analyze the variance in per-person utilization of substance abuse treatment services that are financed by the public-sector through Medicaid and block grant funds. Methods such as reducing the influence of outliers on total payment amounts and developing multivariate statistical explanatory models will be used to investigate the potential empirical performance of prospective payments known as case rates. Under a case rate payment system, providers would receive an average payment to cover substance abuse treatment services for a client for a specified period of time. The study will generate options for payment system reform that are based on paying case rates to providers, giving full consideration to potential positive results such as improved efficiency and retention in treatment, as well as potential pitfalls associated with payment errors or reduced access to care. The empirical analyses will be based on data for publicly financed substance abuse clients in Massachusetts, covered by Medicaid and/or the Bureau of Substance Abuse Services. Treatment clients will be categorized into financial rate cells, taking into account important differences in patient and provider characteristics. Other payment system features will be addressed, including risk sharing arrangements and whether clients need to be locked into closed networks. Simulations will be conducted of the potential performance outcomes for payers and providers using various assumptions about policy parameters chosen for the payment system, as well as behavioral responses such as favorable risk selection by providers. The result could inform State agencies or other payers that may contemplate moving from a fee-for-service payment system toward managed-care models.

本研究将分析由公共部门通过医疗补助和整体补助基金资助的药物滥用治疗服务的人均利用率差异。减少异常值对总支付金额的影响和开发多元统计解释模型等方法将用于调查预期支付的潜在实证表现，即案件率。在个案费率支付制度下，提供者将在特定时期内为客户支付药物滥用治疗服务的平均费用。这项研究将为支付系统改革提供备选方案，这些方案的基础是向提供者支付病例率，充分考虑到潜在的积极结果，如提高效率和保留治疗，以及与支付错误或减少获得医疗服务有关的潜在陷阱。实证分析将基于马萨诸塞州公共资助的药物滥用客户的数据，这些客户由医疗补助计划和/或药物滥用服务局覆盖。考虑到患者和提供者特征的重要差异，治疗客户将被分类为财务费率单元。支付系统的其他功能将得到解决，包括风险分担安排，以及客户是否需要被锁定在封闭的网络中。将对付款人和提供者的潜在绩效结果进行模拟，使用关于为支付系统选择的政策参数的各种假设，以及提供者的有利风险选择等行为反应。研究结果可以告知州政府机构或其他支付方，他们可能会考虑从按服务收费的支付系统转向管理式医疗模式。