Merrick E L
Institute for Health Policy, Heller Graduate School, Brandeis University, Waltham, MA 02454, USA.
Psychiatr Serv. 1998 Dec;49(12):1563-7. doi: 10.1176/ps.49.12.1563.
The study examined utilization, payments, and quality indicators for treatment of major depressive disorder before and after the 1993 implementation of a behavioral health care carve-out plan for Massachusetts state employees who received medical coverage through indemnity plans or preferred provider organizations.
The sample of 2,259 enrollees with claims for treatment of major depressive disorder was drawn from the group of 39,541 persons continuously enrolled in preferred provider organizations or indemnity plans for fiscal years 1992 to 1995. A subsample of 243 users of inpatient services accounted for 352 admissions. Bivariate tests were used to compare utilization and quality indicators before and after implementation of the carve-out plan. Simple comparisons of current-year dollars were used.
The proportion of enrollees with claims for treatment of major depressive disorder increased significantly under the carve-out plan. Inpatient utilization decreased substantially, mostly due to a significantly lower average length of stay (16 days before implementation of the carve-out plan and nine days after). Net inpatient payments fell 71 percent overall, 65 percent per admission, and 40 percent per day. The unadjusted proportion of discharged patients treated for major depressive disorder who were readmitted within 15 and 30 days did not change significantly. The unadjusted proportion of cases receiving follow-up within those time frames increased significantly.
Implementation of a behavioral health carve-out plan may be accompanied by substantial reductions in inpatient utilization and payments for treatment of major depressive disorder. Descriptive findings suggest that such reductions may not have a detrimental impact on readmission and follow-up treatment rates within 30 days. However, this analysis did not control for patient characteristics, used short follow-up periods, and did not include some relevant outcome measures.
本研究调查了1993年马萨诸塞州为通过赔偿计划或优选医疗机构获得医疗保险的州政府雇员实施行为健康医疗分离计划前后，重度抑郁症治疗的利用率、支付情况及质量指标。
从1992年至1995年连续参保优选医疗机构或赔偿计划的39541人中抽取了2259名有重度抑郁症治疗索赔记录的参保者作为样本。243名住院服务使用者的子样本涉及352次住院。采用双变量检验比较分离计划实施前后的利用率和质量指标。使用当年美元进行简单比较。
在分离计划下，有重度抑郁症治疗索赔记录的参保者比例显著增加。住院利用率大幅下降，主要原因是平均住院天数显著缩短（分离计划实施前为16天，实施后为9天）。住院支付净额总体下降71%，每次住院下降65%，每天下降40%。因重度抑郁症接受治疗的出院患者在15天和30天内再次入院的未调整比例没有显著变化。在这些时间段内接受随访的病例未调整比例显著增加。
行为健康分离计划的实施可能伴随着重度抑郁症治疗住院利用率和支付的大幅降低。描述性研究结果表明，这种降低可能不会对30天内的再入院率和后续治疗率产生不利影响。然而，该分析未对患者特征进行控制，随访期较短，且未纳入一些相关结局指标。
