Medicaid cutbacks and clients with severe mental illness

医疗补助削减和患有严重精神疾病的客户

• 批准号: 7104645
• 负责人: BENTSON H MCFARLAND
• 金额: $ 7.66万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-03-09 至 2008-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7104645
• 关键词: Medicare /Medicaid; behavioral /social science research tag; bipolar depression; governmental health /scientific organization; health care policy; health economics; health services research tag; hospital utilization; human data; human mortality; legal /correctional; medical indigency; medical records; mental health epidemiology; mental health services; organized financing; schizophrenia

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.

描述（由申请人提供）：该提案是对申请号R03 MH074471-01的修订版，由精神健康服务研究审查委员会2005年2月9日审查。该申请已进行了基本修订，以解决审阅者的评论。数据库描述已经扩展，更好地描述了结果指标，分析计划和功率计算已简化和澄清，并且预算已重新分配。同时，决策者对减少医疗补助对严重精神疾病的人的影响仍然非常感兴趣。实际上，患有严重精神疾病的人，例如精神分裂症或躁郁症，在很大程度上取决于医疗补助，以支付包括门诊护理和药物在内的服务。不幸的是，各州最近减少了医疗补助的入学率和或福利。拟议的联邦预算还预计医疗补助中会显着收缩。减少该服务的影响还有待观察。然而，这些信息将引起政策制定者的极大兴趣。俄勒冈州提供了可能是该国最戏剧性的医疗补助入学率和福利降低的例子。从2000年开始，俄勒冈州面临着与制造业，出口和高科技下降有关的大量失业。作为回应，俄勒冈州立法机关消除了大量人的所有医疗补助覆盖范围，同时减少了其他医疗补助客户群体的心理健康，滥用药物和或药房的福利。拟议的二级数据分析项目的目的是检查这些削减对严重和持续性精神疾病（例如精神分裂症或躁郁症）的人的影响。这项观察性研究将检查俄勒冈州医疗补助客户在2003年和2004年大规模降低医疗补助之前使用精神卫生服务的客户。数据将从国家心理健康机构，州医疗补助机构，州警察，监狱系统，警长，警长和州维特统计局运营的几个链接信息系统中获得。结果措施将包括精神科住院，逮捕和死亡率。这些事件的比率将在客户曾经和未接受门诊服务和或药物的时间段之间进行比较。对于可能住院或被捕的受试者，分析将考虑到不同的“危险时间”。确定医疗补助政策的决策者将对结果产生浓厚的兴趣。