Bloom Joan R, Cheng Jur-Shan, Hu Teh-wei, Kang Soo Hyang, Wallace Neal
School of Public Health, Uuniversity of California, Berkeley, CA 94720-7360, USA.
J Ment Health Policy Econ. 2003 Dec;6(4):163-71.
In 1995 in an effort to control costs, the State of Colorado implemented a pilot capitated payment system for individuals eligible for public financing of their mental health services. Contracts were with both Not-For-Profit (NFP) firms and For-Profit (FP) firms; the remainder were in the fee-for-service system (FFS). Pharmaceuticals were not included in the capitation rate. However, antipsychotic medications were included in the formularies for consumers who received their medical care through a Health Maintenance Organization (HMO).
This paper examines the use of antipsychotic medication compared to the use of atypical antipsychotics among consumers who are (i) enrolled in a medical HMO or not enrolled in a medical HMO and (ii) whose mental health services are reimbursed on a fee-for-service basis (FFS) or through a capitated system.
Data for this study were collected between 1995 and 1997 as part of the Colorado's Medicaid Mental Health Capitation Pilot Program. Atypical antipsychotics included in the study are: clozapine, risperidone, and olanzapine. The sample of this study consisted of 282 individuals diagnosed with schizophrenia.
The utilization of antipsychotics was lower among consumers in HMOs. Compared to consumers in FFS areas of the state, the utilization of atypical antipsychotics was higher in capitated areas of the state.
There was a strong incentive for the utilization of atypical antipsychotics to increase in capitated systems, unless consumers received their medication prescriptions through an HMO. Limitations include differences in observable and unobservable characteristics among the FFS, DC and MBHO areas, unavoidable selection bias and the small number of HMO enrollees.
Capitation of mental health services provides incentives for more cost-effective treatments. HMO enrollment was not a crucial factor to determine access to atypical antipsychotic prescriptions.
These data suggest that capitation can affect the use of substitute services not in the capitation rate. Before recommending policy changes, we need to better understand whether the increased utilization leads to better outcomes.
The next step is to determine whether the increased use of atypical antipsychotics leads to better outcomes for consumers.
1995年，为控制成本，科罗拉多州针对符合心理健康服务公共融资条件的个人实施了一项预付制试点支付系统。合同授予了非营利性（NFP）公司和营利性（FP）公司；其余则采用按服务收费系统（FFS）。药品费用不包含在人均费用率中。然而，抗精神病药物被纳入了通过健康维护组织（HMO）接受医疗服务的消费者的处方集。
本文研究了在（i）参加医疗健康维护组织（HMO）或未参加医疗健康维护组织的消费者中，以及（ii）心理健康服务按服务收费（FFS）或通过预付制系统报销的消费者中，抗精神病药物与非典型抗精神病药物的使用情况。
本研究的数据收集于1995年至1997年期间，作为科罗拉多州医疗补助心理健康预付制试点项目的一部分。本研究纳入的非典型抗精神病药物有：氯氮平、利培酮和奥氮平。本研究样本包括282名被诊断为精神分裂症的个体。
健康维护组织（HMO）中的消费者使用抗精神病药物的比例较低。与该州按服务收费（FFS）地区的消费者相比，该州预付制地区非典型抗精神病药物的使用比例更高。
在预付制系统中，使用非典型抗精神病药物的动机很强，除非消费者通过健康维护组织（HMO）获得药物处方。局限性包括按服务收费（FFS）、直接承保（DC）和管理式行为健康组织（MBHO）地区之间可观察和不可观察特征的差异、不可避免的选择偏差以及健康维护组织（HMO）参保人数较少。
心理健康服务的预付制为更具成本效益的治疗提供了激励。参加健康维护组织（HMO）并非决定是否能获得非典型抗精神病药物处方的关键因素。
这些数据表明，预付制会影响未包含在人均费用率中的替代服务的使用。在建议政策变革之前，我们需要更好地了解使用增加是否会带来更好的结果。
下一步是确定增加使用非典型抗精神病药物是否会为消费者带来更好的结果。
