Landers Glenn, Zhou Mei
Georgia State University-Georgia Health Policy Center.
Medicare Medicaid Res Rev. 2014 Feb 18;4(1). doi: 10.5600/mmrr.004.01.a04. eCollection 2014.
Peer support programs have proliferated over the past decade, building on recovery oriented programming, yet relationships between peer support services and the costs to public programs have not been well described in literature. The purpose of this study is to fill gaps in the literature related to peer support programs and cost: lack of comparison groups, small sample sizes, and the availability of research examining utilization of Medicaid mental health services.
The study employed a retrospective design with treatment and comparison groups created from three administrative databases. Three ordinary least squares regression models were constructed to predict crisis stabilization cost, psychiatric hospitalization cost, and total Medicaid cost while controlling for other factors. The Chronic Illness and Disability Payment System + Rx was used to control for illness severity.
Peer support was associated with $5,991 higher total Medicaid cost (p < .01). Peer support was also associated with higher crisis stabilization cost and lower psychiatric hospitalization cost, but the relationships were not statistically significant. Peer support was associated with $2,100 higher prescription drug cost (p < .01), $5,116 higher professional services cost (p < .01), and $1,225 lower facility cost (p < .01).
While the implementation of Medicaid financed peer support programs may not result in savings from reductions of costly crisis stabilizations and psychiatric hospitalizations, it does support the principles of self-direction and recovery from severe mental illness. State policy makers must weigh the potential higher cost associated with peer support programs with efforts to redesign the delivery of mental health services.
在过去十年中，同伴支持项目不断增加，基于以康复为导向的规划，但同伴支持服务与公共项目成本之间的关系在文献中尚未得到充分描述。本研究的目的是填补与同伴支持项目和成本相关的文献空白：缺乏对照组、样本量小以及缺乏对医疗补助心理健康服务利用情况的研究。
该研究采用回顾性设计，从三个行政数据库中创建治疗组和对照组。构建了三个普通最小二乘回归模型，以预测危机稳定成本、精神科住院成本和医疗补助总成本，同时控制其他因素。使用慢性病和残疾支付系统+处方来控制疾病严重程度。
同伴支持与医疗补助总成本高出5991美元相关（p <.01）。同伴支持还与较高的危机稳定成本和较低的精神科住院成本相关，但这些关系在统计学上并不显著。同伴支持与处方药成本高出2100美元相关（p <.01），专业服务成本高出5116美元相关（p <.01），设施成本低1225美元相关（p <.01）。
虽然医疗补助资助的同伴支持项目的实施可能不会因减少昂贵的危机稳定和精神科住院而节省成本，但它确实支持自我导向和从严重精神疾病中康复的原则。州政策制定者必须权衡与同伴支持项目相关的潜在更高成本与重新设计心理健康服务提供方式的努力。
