Department of Mental Health Law and Policy, University of South Florida, Tampa, FL 33612, USA.
Pharmacoeconomics. 2012 May;30(5):387-96. doi: 10.2165/11539830-000000000-00000.
Many Medicaid programmes now offer behavioural healthcare through managed care organizations. Medicaid programmes are concerned about carve-outs because the use of non-included services may rise, limiting the efficiencies anticipated with the implementation of managed care. There also exist concerns that patients with serious mental illness may receive reduced care through managed care and consequently have poorer outcomes.
This study examined prescription drug utilization among Medicaid recipients with the implementation of a mental health carve-out plan in Florida. In particular, this study examined short-run changes in the utilization of antipsychotic medications among individuals diagnosed with schizophrenia or episodic mood disorders with the implementation of Prepaid Mental Health Plans (PMHPs) in Florida Medicaid.
This study used Medicaid data from 38 counties in Florida that implemented the PMHP programme in 2005 and 2006. The sample was limited to individuals aged≤64 years who were continuously enrolled in Medicaid. Individuals were required to have at least two diagnoses of schizophrenia, episodic mood disorders, delusional disorders or other nonorganic disorders (three-digit International Classification of Diseases, Ninth Revision [ICD-9] code of 295-298). Five different outcome measures were examined on a monthly basis for the 6 months pre- and post-PMHP implementation: penetration; adherence; Medicaid expenditures for antipsychotics; polypharmacy (multiple antipsychotic medications); and whether dosing was within guidelines. Generalized estimating equations were used to estimate associations between individual and insurance characteristics, and the outcome variables. The analyses were conducted using SAS procedure GENMOD. Empirical (robust) standard errors were calculated to account for repeated observations on the same individual.
There were 153,720 monthly observations for the 12,810 people in the sample. Seventy-four percent of the sample was aged between 21 and 54 years, while 65% were female, 30% White, 14% Black and 44% Hispanic. The large proportion of Hispanics stems from the introduction of the PMHP programme in Dade County (Miami). The results indicate the implementation of the PMHP was associated with increased penetration, but reduced adherence, polypharmacy and expenditures by the Medicaid agency. There was no change in the likelihood of prescriptions being written within recommended dosage ranges.
The introduction of the PMHP was associated with short-run changes in medication utilization among individuals with serious mental illness.
许多医疗补助计划现在通过管理式医疗组织提供行为健康服务。医疗补助计划对“切块式服务”表示担忧，因为非纳入服务的使用可能会增加，从而限制了管理式医疗实施所预期的效率。此外，还有人担心患有严重精神疾病的患者可能会通过管理式医疗获得较少的护理，从而导致结果较差。
本研究调查了佛罗里达州实施精神卫生切块计划后医疗补助受助人的处方药使用情况。具体而言，本研究调查了佛罗里达州医疗补助计划中预付精神健康计划（Prepaid Mental Health Plans，PMHP）实施后，被诊断患有精神分裂症或间歇性情绪障碍的个体的抗精神病药物使用的短期变化。
本研究使用了来自佛罗里达州 38 个县的医疗补助数据，这些县在 2005 年和 2006 年实施了 PMHP 计划。样本仅限于年龄≤64 岁且连续参加医疗补助的个体。个体需要至少有两次精神分裂症、间歇性情绪障碍、妄想障碍或其他非器质性障碍的诊断（国际疾病分类，第九版[ICD-9]代码 295-298）。在 PMHP 实施前和实施后 6 个月内，每月对以下五个不同的结果指标进行检查：渗透率；用药依从性；医疗补助用于抗精神病药物的支出；多种药物治疗（多种抗精神病药物）；以及剂量是否符合指南。使用广义估计方程估计个体和保险特征与结果变量之间的关联。分析使用 SAS 程序 GENMOD 进行。为了考虑同一个体的重复观察，计算了经验（稳健）标准误差。
样本中 12810 人的 153720 个月度观察结果。74%的样本年龄在 21 至 54 岁之间，65%为女性，30%为白人，14%为黑人，44%为西班牙裔。西班牙裔的比例较大是因为迈阿密戴德县（Dade County）引入了 PMHP 计划。结果表明，PMHP 的实施与严重精神疾病患者用药渗透率的增加有关，但与用药依从性、多种药物治疗和医疗补助机构支出的减少有关。处方剂量在推荐范围内的可能性没有变化。
PMHP 的引入与严重精神疾病患者药物使用的短期变化有关。
