Medicaid cutbacks and clients with severe mental illness

描述(申请人提供)：本建议书是由精神健康服务研究评审委员会于2005年2月9日评审的R03 MH074471-01号申请书的修订版。该应用程序已进行了重大修改，以处理审阅者的意见。扩大了数据库说明，更好地说明了成果措施，简化和澄清了分析计划和权力计算，并重新分配了预算。与此同时，政策制定者仍然对削减医疗补助对患有严重精神疾病的个人的影响非常感兴趣。事实上，患有严重精神疾病(如精神分裂症或双相情感障碍)的人严重依赖医疗补助来支付包括门诊护理和药物治疗在内的服务。不幸的是，各州最近减少了医疗补助的登记和/或福利。拟议的联邦预算还预计医疗补助将显著缩水。这种服务减少的影响还有待观察。然而，这些信息将会引起政策制定者的极大兴趣。俄勒冈州提供了很可能是全国最戏剧性的医疗补助登记和福利削减的例子。从2000年开始，俄勒冈州面临着与制造业、出口和高科技下降相关的大量失业。作为回应，俄勒冈州立法机构取消了针对大量人的所有医疗补助覆盖范围，同时限制了精神健康、药物滥用和-或其他医疗补助客户群体的药房福利。拟议的二级数据分析项目的目的是检查这些削减对患有严重和持续性精神疾病(如精神分裂症或双相情感障碍)的人的影响。这项观察性研究将考察俄勒冈州医疗补助计划的客户，他们在该州2003年和2004年大规模削减医疗补助计划之前使用过精神健康服务。数据将从州精神卫生机构、州医疗补助机构、州警察、监狱系统、治安官和州生命统计机构运营的几个相互关联的信息系统中获得。结果衡量标准将包括精神病住院、逮捕和死亡率。这些事件的发生率将在客户接受和没有接受门诊服务和/或药物治疗的时间段进行比较。分析将考虑到可能住院或被捕的受试者的不同“风险时间”。这一结果将引起决定医疗补助政策的决策者的浓厚兴趣。

DESCRIPTION (provided by applicant): This proposal is a revision of application number R03 MH074471-01 which was reviewed February 9, 2005 by the Mental Health Services Research Review Committee. The application has been substantially revised to address reviewer comments. Data base descriptions have been expanded, outcome measures are better described, the analysis plan and power calculations have been simplified and clarified, and the budget has been re-allocated. In the meantime, policy-makers remain greatly interested in the impact of Medicaid reductions on individuals with severe mental illness. Indeed, people with severe mental illnesses such as schizophrenia or bipolar disorder depend heavily on Medicaid to pay for services including outpatient care and medications. Unfortunately, states have recently reduced Medicaid enrollment and-or benefits. The proposed federal budget also anticipates notable shrinkage in Medicaid. The impact of this service reduction remains to be seen. Yet this information will be of considerable interest to policy-makers. Oregon provides what may well be the nation's most dramatic example of Medicaid enrollment and benefit reductions. Beginning in 2000, Oregon faced substantial unemployment associated with declines in manufacturing, exports, and high technology. In response, the Oregon legislature eliminated all Medicaid coverage for large numbers of people while curtailing mental health, substance abuse, and-or pharmacy benefits for other groups of Medicaid clients. The purpose of the proposed secondary data analysis project is to examine the impact of these cutbacks on people with severe and persistent mental illnesses such as schizophrenia or bipolar disorder. This observational study will examine Oregon Medicaid clients who had used mental health services prior to the state's massive Medicaid reductions in 2003 and 2004. Data will be obtained from several linked information systems operated by the state mental health agency, the state Medicaid agency, the state police, the prison system, sheriffs, and the state vital statistics agency. Outcome measures will include psychiatric hospitalizations, arrests, and mortality. Rates of these events will be compared between time periods when clients were and were not receiving outpatient services and-or medication. Analyses will take into account varying "times at risk" for subjects who may be hospitalized or arrested. The results will be of keen interest to decision-makers who determine Medicaid policies.