Medicaid Capitation: Cost Shifting & Multisystem Use

医疗补助按人头付费：成本转移

• 批准号: 6796634
• 负责人: Joseph P. Morrissey
• 金额: $ 69万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-01 至 2006-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6796634
• 关键词: Medicare /Medicaid; age difference; behavioral /social science research tag; behavioral medicine; clinical research; correctional institutions; cost effectiveness; gender difference; health care policy; health care service utilization; health economics; human data; longitudinal human study; managed care; mathematical model; medical indigency; medically underserved population; mental health services; racial /ethnic difference; socioeconomics; substance abuse related behavior

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.

描述（由申请人提供）：大多数关于管理心理健康的研究