Medicaid Capitation: Cost Shifting & Multisystem Use

描述（由申请人提供）：大多数关于心理健康管理的研究 医疗保健的重点是其对心理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然未知。这些 潜在的系统间效应尤其重要，因为大量的 需要心理健康服务的人被关押在监狱里， 拘留率继续呈天文数字上升。 本提案提出了一项为期三年的纵向研究计划 （2002-2005）医疗补助按人头收费对使用多种系统的影响 在华盛顿的金郡（西雅图），这是第一个全面的， 基于人口的努力，以评估受管理的 行为健康保健和成本从行为健康转移到地方监狱。 在一项初步研究中，我们获得了5万名金郡居民的记录， 从1993年到1998年为了评估人头税的影响，我们将收集更多的 同一（患病率）队列的数据，加上另外50，000名新受试者 1999-2003年五年期。这些额外的队列将 从医疗补助登记记录，监狱拘留记录， 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采样。按着我们 在此之前，我们建议提取由六个机构保存的电子使用记录， 不同的州和地方机构，这将包括使用记录， 心理健康提供者、药物滥用提供者、监狱和监狱 临床医生、综合医院和一般医疗补助提供者。分析将 包括计量经济学建模和层次回归和多变量 评估管理式医疗对系统间总体趋势的影响 服务使用和成本转移。 调查结果将针对各种地方和国家受众 委员会关注改善对所涉各人口群体的照顾。

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.