Ettner Susan L, Denmead Gabrielle, Dilonardo Joan, Cao Hui, Belanger Albert J
UCLA Department of Medicine, Division of General Internal Medicine & Health Services Research, 911 Broxton Plaza, Room 106, Box 951736, Los Angeles, CA 90095-1736, USA.
J Behav Health Serv Res. 2003 Jan-Feb;30(1):41-62. doi: 10.1007/BF02287812.
The introduction of Medicaid managed care raises concern that profit motives lead to the undersupply of substance abuse (SA) services. To test effects of the Maryland Medicaid HealthChoice program on SA treatment patterns and outcomes, Medicaid eligibility files were linked to treatment provider records and two study designs were used to estimate program impact: a quasi-experimental design with matched comparison groups and a natural experiment. Patient sociodemographic and clinical characteristics were adjusted using multiple regression. Under managed care, there was a shift from residential, correctional-only, and detoxification-only treatment toward outpatient-only treatment. Among beneficiaries entering treatment, those enrolled in managed care organizations (MCOs) had similar utilization and outcomes to those in Medicaid fee-for-service; those enrolling in MCOs during treatment had longer and more intensive episodes and, as a result, better outcomes. Thus, the study disclosed no empirical evidence that health plans respond to capitation by reducing SA services.
医疗补助管理式医疗的引入引发了人们的担忧，即盈利动机可能导致药物滥用（SA）服务供应不足。为了测试马里兰州医疗补助健康选择计划对药物滥用治疗模式和结果的影响，将医疗补助资格档案与治疗提供者记录相链接，并采用了两种研究设计来评估该计划的影响：一种是带有匹配对照组的准实验设计，另一种是自然实验。使用多元回归对患者的社会人口统计学和临床特征进行了调整。在管理式医疗模式下，治疗方式从住院治疗、仅矫正治疗和仅戒毒治疗转向了仅门诊治疗。在开始接受治疗的受益人中，加入管理式医疗组织（MCO）的人与参加按服务收费医疗补助的人在利用率和治疗结果方面相似；在治疗期间加入MCO的人治疗时间更长、强度更大，因此治疗效果更好。因此，该研究没有发现实证证据表明健康计划会通过减少药物滥用服务来应对按人头付费。
