Bigelow Douglas A, McFarland Bentson H, McCamant Lynn E, Deck Dennis D, Gabriel Roy M
Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Gaines Hall 155, Portland, OR 97239, USA.
Psychiatr Serv. 2004 Jul;55(7):775-9. doi: 10.1176/appi.ps.55.7.775.
Mental health services are important to treatment retention and positive outcomes for many clients of substance abuse treatment programs. For these clients the implementation of managed care should provide for continued or increased access to mental health treatment, rather than decreased access because of short-term, cost-reduction objectives. This study assessed whether converting Medicaid from a fee-for-service program to a capitated, prepaid managed care program affected access to mental health services among clients who were treated for substance abuse.
Medicaid enrollees who were being treated for substance abuse in Oregon were interviewed before beginning treatment and after six months of service. One cohort (N=53) was interviewed one to six months before the implementation of managed care, a second (N=66) was interviewed two years after the implementation, and a third (N=49) was interviewed three to four years after the implementation. Logistic regression analyses were used to identify whether the implementation of managed care, the psychiatric need of the client, and other client characteristics affected the receipt of mental health services during the first six months of substance abuse treatment.
Clients in all three cohorts had similar characteristics. The implementation of managed care did not affect whether clients received mental health services. A baseline interview score that was derived from items in the Addiction Severity Index psychiatric section was the only client characteristic that predicted receipt of mental health services.
Although this study was a naturalistic experiment with many methodologic flaws, it provided a unique opportunity to observe whether the introduction of managed care changed access to mental health services among Medicaid enrollees who were being treated for substance abuse.
心理健康服务对于许多药物滥用治疗项目的客户维持治疗及取得积极治疗效果至关重要。对于这些客户而言，实施管理式医疗应确保他们能够持续获得或增加获得心理健康治疗的机会，而不是因为短期的成本削减目标而减少治疗机会。本研究评估了将医疗补助从按服务收费项目转变为按人头预付的管理式医疗项目是否会影响接受药物滥用治疗的客户获得心理健康服务的情况。
对俄勒冈州正在接受药物滥用治疗的医疗补助参保者在开始治疗前及服务6个月后进行访谈。一组（N = 53）在管理式医疗实施前1至6个月接受访谈，第二组（N = 66）在实施两年后接受访谈，第三组（N = 49）在实施三至四年后接受访谈。采用逻辑回归分析来确定管理式医疗的实施、客户的精神需求以及其他客户特征是否会影响药物滥用治疗前六个月内心理健康服务的接受情况。
所有三组客户的特征相似。管理式医疗的实施并未影响客户是否接受心理健康服务。来自成瘾严重程度指数精神科部分项目的基线访谈得分是唯一能预测接受心理健康服务情况的客户特征。
尽管本研究是一项存在诸多方法学缺陷的自然实验，但它提供了一个独特的机会来观察管理式医疗的引入是否改变了接受药物滥用治疗的医疗补助参保者获得心理健康服务的情况。
