Medicaid Capitation: Cost Shifting & Multisystem Use

描述(申请人提供)：管理性心理健康研究最多 CARE的重点是它对精神健康的直接临床和财政影响 服务。然而，它对其他系统的影响在很大程度上仍是未知的。这些 潜在的系统间影响尤其重要，因为 有精神健康服务需要的人被拘留在监狱里， 拘留率继续以天文数字的速度上升。 该提案提出了一项为期三年的纵向研究计划。 (2002-2005)医疗补助计划对多种系统使用的影响 在华盛顿州金县(西雅图)罕见。这是第一个全面的， 基于人口的工作，以评估托管服务的系统间影响 行为健康保健和成本从行为健康转移到当地监狱。 在初步研究中，我们获得了50,000名金县居民的记录 从1993年到1998年。为了评估捕获的影响，我们将收集其他 关于同一(流行率)队列的数据，外加额外的50,000名新受试者 1999-2003年这五年期间。这些额外的队列将是 从医疗补助登记记录、监狱拘留记录和 心理健康利用记录，并将使用我们以前的方法， 对在多个系统中有记录的受试者进行过抽样。就像我们所做的那样 在此之前，我们建议提取由六家公司保存的电子使用记录 不同的州和地方机构，这将包括来自 精神健康提供者、药物滥用提供者、监狱和监狱 临床医生、综合医院和综合医疗补助提供者。分析将 由计量经济模型、层次回归和多指标组成 评估管理型医疗服务对总体趋势、系统间影响的日志 服务使用和成本转移。 调查结果将针对不同的地方和国家受众 关注改善对所涉各种人口群体的照顾。

DESCRIPTION (provided by applicant): Most research on managed mental health care has focused on its direct clinical and fiscal impacts on mental health services. However, its impacts on other systems remain largely unknown. These potential intersystem effects are especially important as a large number of persons with mental health services needs are detained in jails, and jail detention rates continue their astronomical rise. This proposal presents a research plan for a three-year longitudinal study (2002-2005) of the impact of Medicaid capitation on the use of multiple systems of rare in King County (Seattle) Washington. This is the first comprehensive, population based effort to assess the inter-system impacts of managed behavioral health care and cost shifting from behavioral health to local jails. In a preliminary study, we obtained records on 50,000 King County residents from 1993-1998. To assess the effects of capitation, we will gather additional data on this same (prevalence) cohort, plus an additional 50,000 new subjects for the five-year time period of 1999-2003. These additional cohorts will be selected from the Medicaid enrollment records, jail detention records, and mental health utilization records, and will use our previous methodology that over-samples subjects who have records in multiple systems. As we have done before, we propose to draw electronic utilization records maintained by six different state and local agencies, that will include utilization records from mental health providers, substance abuse providers, jails and jail based clinicians, general hospitals, and general Medicaid providers. Analyses will consist of econometric modeling and hierarchical regressions and multinumeral logits to assess the impact of managed care on overall trends, intersystem service use, and cost-shifting. Findings will be targeted to a variety of local and national audiences concerned about improving care for the various population groups involved.