Mental Health Spending and Quality of Care

描述（由申请人提供）：对医疗保险中支出和质量的区域差异的研究表明，较高的支出水平与较高的医疗质量并不呈正相关，在某些情况下是负相关的。这些发现导致一些人认为，在该国许多地区，可以大幅减少支出，而不会对医疗质量造成任何有意义的损失。这种看法危及公众将资源用于卫生保健的承诺。2007年6月，国会预算办公室主任在参议院预算委员会作证时表示，支出变化与质量之间的微弱联系表明，成本控制机会不会影响结果。旨在了解支出变化与质量之间联系的研究对公共政策至关重要。在提供精神卫生服务方面，这些问题几乎没有得到重视。在心理健康领域研究这些问题尤其重要，因为心理健康支出的更大份额是由政府承担的（而不是一般医疗保健），因此是公共政策的范畴。我们建议通过以下三个具体目标来解决这些重要问题。目标1：使用医疗补助申请数据来定义一系列质量、可及性和支出措施，这些措施与国家对患有严重精神疾病和其他精神疾病的个人的政策相关。我们将描述这些措施的变化，并对当地精神卫生保健系统的表现进行基本总结。我们的实证分析将集中在佛罗里达州和加利福尼亚州的纵向数据上，并通过检查其他10个州医疗补助计划的变化，将这些模式置于更大的背景下。目标2：估计质量、获取和支出之间的因果关系。我们将在个人层面上估计特定疾病的支出模型。我们还比较了地方一级精神疾病的质量和支出指标与其他医疗条件的关系，包括：糖尿病、充血性心力衰竭（CHF）、哮喘、冠状动脉疾病和慢性阻塞性肺疾病（COPD）。目标3：作为试点，提出并实施“县精神卫生系统报告卡”，供州精神卫生政策领导使用。报告卡将在国家医疗补助计划和心理健康政策制定者的帮助下制定。本应用程序侧重于健康和精神卫生保健中最关键的政策研究问题之一：我们如何理解在精神卫生支出、质量和获得护理方面观察到的变化？人们对心理健康领域的这种差异知之甚少。我们扩展了变异科学的方法，并利用医疗补助计划的数据将其应用于精神卫生保健。

DESCRIPTION (provided by applicant): Research on regional variation in spending and quality within Medicare has shown that higher levels of spending are not positively correlated with higher quality of care and in some cases are negatively correlated. These findings have led some to suggest that spending in many areas of the country can be reduced sharply without any meaningful loss in the quality of care. Such observations jeopardize public commitment to devoting resources to health care. The Director of the Congressional Budget Office in his testimony before the Senate Budget Committee in June of 2007 suggested that the weak link between variation in spending and quality pointed toward cost control opportunities that will not affect outcomes. Research aimed at understanding the links between variation in spending and quality is of central importance for public policy. Almost no attention has been given these issues in the area of mental health delivery. It is especially important to study these issues in the mental health arena since a larger share of mental health spending is borne by government (than for general medical care) and therefore the province of public policy. We propose to address these important issues by pursuing the following three specific aims. AIM 1: To use Medicaid claims data to define a series of quality, access and spending measures relevant to state policy for individuals with severe mental illness and other mental illnesses. We will characterize the variation in these measures and produce basic summaries of local mental health care system performance. Our empirical analysis will focus on longitudinal data from the states of Florida and California and put those patterns into a larger context by examining variation within 10 other state Medicaid programs. AIM 2: To estimate the causal link between quality and access and spending. We will estimate models of disease-specific spending at the individual level. We also compare the relationship of quality and spending indicators at the local level for mental illness to the relationships for other medical conditions including: diabetes, congestive heart failure (CHF), asthma, coronary artery disease, and chronic obstructive pulmonary disease (COPD). AIM 3: To propose and implement as a pilot a "County Mental Health System Report Card" for use by state mental health policy leadership. The Report Card will be developed with the aid of state Medicaid and mental health policy makers. This application focuses on one of the most critical policy research questions in health and mental health care: How do we understand observed variation in mental health spending, quality and access to care? Little is known about such variation in the mental health area. We expand methods of the science of variations and apply them to mental health care using data from the Medicaid program.