Norton E C, Lindrooth R C, Dickey B
Department of Health Policy and Administration, School of Public Health, University of North Carolina, Chapel Hill 27599-7400, USA.
Ment Health Serv Res. 1999 Sep;1(3):185-96. doi: 10.1023/a:1022377930099.
We conducted a study of the change from fee-for-service to managed care for mental health services in the Massachusetts Medicaid program, which occurred in fiscal year 1993. We estimated the effect of managed care on total public expenditures over both the short and the long term. Per person expenditures were lower by 24% in the first year of managed care but only lower by 5% in the second and third years. We also tested for cost-shifting by estimating expenditures for five specific services paid by three public agencies. Expenditures on services paid by the managed care vendor decreased, expenditures paid by Medicaid increased, and expenditures paid by the Department of Mental Health decreased. We discuss the implications for both cost-shifting and quality of care improvements. The results from two-part expenditure models indicate that some cost-shifting may be related to quality improvement. The effects are generally stronger for the beneficiaries in the highest quartile of expenditures.
我们对1993财年马萨诸塞州医疗补助计划中精神卫生服务从按服务收费转变为管理式医疗进行了一项研究。我们估计了管理式医疗在短期和长期内对公共总支出的影响。在管理式医疗的第一年，人均支出降低了24%，但在第二年和第三年仅降低了5%。我们还通过估计三个公共机构支付的五项特定服务的支出，来测试成本转移情况。由管理式医疗供应商支付的服务支出减少，医疗补助支付的支出增加，而心理健康部支付的支出减少。我们讨论了成本转移和改善护理质量的影响。两部分支出模型的结果表明，一些成本转移可能与质量改善有关。对于支出处于最高四分位数的受益人，影响通常更强。
