Medicaid Capitation: Cost Shifting & Multisystem Use

描述（由申请人提供）：大多数关于管理心理健康的研究 护理重点关注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仍然很大程度上未知。这些 潜在的系统间影响尤其重要，因为大量 有精神卫生服务需求的人被关押在监狱中，并且监狱 拘留率继续呈天文数字上升。 该提案提出了一项为期三年的纵向研究的研究计划 (2002-2005) 医疗补助按人头付费对多种系统使用的影响 华盛顿州金县（西雅图）罕见的。这是第一个综合性的， 以人口为基础的努力来评估受管理的系统间影响 行为健康护理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 位金县居民的记录 从 1993 年到 1998 年。为了评估按人头付费的影响，我们将收集额外的信息 关于同一（患病率）队列的数据，以及另外 50,000 名新受试者的数据 1999-2003 年五年期。这些额外的队列将 从医疗补助登记记录、监狱拘留记录中选择，以及 心理健康利用记录，并将使用我们之前的方法 对在多个系统中有记录的受试者进行过度采样。正如我们所做的那样 之前，我们建议提取由六个人维护的电子使用记录 不同的州和地方机构，其中将包括来自 心理健康服务提供者、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以及多项 logits 评估管理式医疗对整体趋势、系统间的影响 服务使用和成本转移。 调查结果将针对各种当地和全国受众 关心改善对所涉及的不同人群的护理。

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.