The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA.
Health Econ. 2012 Apr;21(4):428-43. doi: 10.1002/hec.1723. Epub 2011 Mar 7.
Newer technologies to treat many mental illnesses have shown substantial heterogeneity in diffusion rates across states. In this paper, I investigate whether variation in the level of managed care penetration is associated with changes in state-level diffusion of three newer classes of psychotropic medications in fee-for-service Medicaid programs from 1991 to 2005. Three different types of managed care programs are examined: capitated managed care, any type of managed care and behavioral health carve-outs. A fourth-order polynomial fixed effect regression model is used to model the diffusion path of newer antidepressant and antipsychotic medications controlling for time-varying state characteristics. Substantial differences are found in the diffusion paths by the degree of managed care use in each state Medicaid program. The largest effect is seen through spillover effects of capitated managed care programs; states with greater capitated managed care have greater initial shares of newer psychotropic medications. The influence of carve-outs and of all types of managed care combined on the diffusion path was modest.
治疗许多精神疾病的新技术在各州的传播率方面表现出显著的异质性。在本文中，我调查了在从 1991 年到 2005 年的以服务为基础的医疗补助计划中，三种新型精神药物在州一级的传播中，管理式医疗渗透率的变化是否与以下情况有关：全民医疗照顾计划中不同类型的管理式医疗计划：有条件付款制管理式医疗、任何类型的管理式医疗和行为健康专项拨款。使用四阶多项式固定效应回归模型，在控制各州随时间变化的特征的情况下，对新型抗抑郁药和抗精神病药物的传播路径进行建模。在每个州的医疗补助计划中，管理式医疗使用程度的不同导致了传播路径的显著差异。通过有条件付款制管理式医疗计划的溢出效应，可以看到最大的影响；有更多有条件付款制管理式医疗的州有更大份额的新型精神药物。专项拨款和所有类型的管理式医疗综合对传播路径的影响是适度的。
