Mental Health Spending and Quality of Care

描述（由申请人提供）：对医疗保险内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护理质量并不呈正相关，在某些情况下呈负相关。这些发现使一些人认为，在该国许多地区的支出可以大幅减少，而不会对护理质量造成任何有意义的损失。这些意见损害了公众对卫生保健投入资源的承诺。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薄弱联系指向了不会影响结果的成本控制机会。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。在提供心理健康服务方面，这些问题几乎没有得到重视。在精神卫生竞技场研究这些问题尤其重要，因为精神卫生支出的较大份额由政府承担（比一般医疗保健），因此属于公共政策的范畴。我们建议通过实现以下三个具体目标来解决这些重要问题。目标1：使用医疗补助索赔数据来定义一系列与严重精神疾病和其他精神疾病患者的国家政策相关的质量，访问和支出措施。我们将描述这些措施的变化，并产生当地精神卫生保健系统的性能的基本摘要。我们的实证分析将集中在纵向数据从佛罗里达和加州的状态，并把这些模式到一个更大的背景下，通过检查10个其他国家的医疗补助计划的变化。目标2：估计质量和获取与支出之间的因果关系。我们将在个人层面上估计疾病特异性支出的模型。我们还比较了当地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。报告卡将在州医疗补助和心理健康政策制定者的帮助下开发。该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：我们如何理解观察到的精神卫生支出，质量和获得护理的变化？人们对心理健康领域的这种差异知之甚少。我们扩大变异科学的方法，并将其应用于心理健康护理使用的数据从医疗补助计划。

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.