TY - JOUR
KW - Adolescent
KW - Aid to Families with Dependent Children/economics
KW - Behavior Therapy/economics
KW - Child
KW - Child Behavior Disorders/diagnosis/economics/therapy
KW - Child, Preschool
KW - Continuity of Patient Care/economics
KW - Cost-Benefit Analysis
KW - Female
KW - Health Expenditures/statistics & numerical data
KW - Humans
KW - Infant
KW - Male
KW - Managed Care Programs/economics
KW - Massachusetts
KW - Medicaid/economics
KW - Outcome and Process Assessment (Health Care)
AU - B. Dickey
AU - S. L. Normand
AU - E. C. Norton
AU - A. Rupp
AU - H. Azeni
A1 - 
AB - OBJECTIVE: The authors investigated changes in treatment patterns and costs of care for children after the implementation of the Massachusetts Medicaid carve-out managed care plan. METHODS: The authors hypothesized that after the introduction of managed care, per-child expenditures would be reduced, continuity of care would not improve, and per-child mental health expenditures would undergo larger reductions for disabled children, compared with children enrolled in the Aid to Families With Dependent Children program. Using data from Medicaid and the Massachusetts Department of Mental Health, the authors studied 16,664 Massachusetts Medicaid beneficiaries aged one to 17 years for whom reimbursement claims were submitted for psychiatric or substance use disorder treatment at least once during the two years before the introduction of managed care (1991 to 1992) or during the two years afterward (1994 to 1995). Multivariate analysis was used to estimate changes in probability of admission, and, among patients admitted, to identify factors accounting for variation in length of stay. To assess the variation in expenditures, we regressed the same variables, using the natural logarithm function to transform total mental health expenditures data and inpatient expenditures data to reduce skewness. RESULTS: After the introduction of managed care, per-child expenditures were lower, especially for disabled children, and the Department of Mental Health was used as a safety net for the most seriously ill children without increasing state expenditures. Continuity of care appeared to decline for disabled children. CONCLUSIONS: It is likely that a combination of factors related to the reported changes in patterns of care and expenditures were responsible for the overall per-child expenditures.
BT - Psychiatric services (Washington, D.C.)
C5 - Financing & Sustainability; Healthcare Policy
CP - 2
CY - United States
IS - 2
JF - Psychiatric services (Washington, D.C.)
N2 - OBJECTIVE: The authors investigated changes in treatment patterns and costs of care for children after the implementation of the Massachusetts Medicaid carve-out managed care plan. METHODS: The authors hypothesized that after the introduction of managed care, per-child expenditures would be reduced, continuity of care would not improve, and per-child mental health expenditures would undergo larger reductions for disabled children, compared with children enrolled in the Aid to Families With Dependent Children program. Using data from Medicaid and the Massachusetts Department of Mental Health, the authors studied 16,664 Massachusetts Medicaid beneficiaries aged one to 17 years for whom reimbursement claims were submitted for psychiatric or substance use disorder treatment at least once during the two years before the introduction of managed care (1991 to 1992) or during the two years afterward (1994 to 1995). Multivariate analysis was used to estimate changes in probability of admission, and, among patients admitted, to identify factors accounting for variation in length of stay. To assess the variation in expenditures, we regressed the same variables, using the natural logarithm function to transform total mental health expenditures data and inpatient expenditures data to reduce skewness. RESULTS: After the introduction of managed care, per-child expenditures were lower, especially for disabled children, and the Department of Mental Health was used as a safety net for the most seriously ill children without increasing state expenditures. Continuity of care appeared to decline for disabled children. CONCLUSIONS: It is likely that a combination of factors related to the reported changes in patterns of care and expenditures were responsible for the overall per-child expenditures.
PP - United States
PY - 2001
SN - 1075-2730; 1075-2730
SP - 183
EP - 188
EP - 
T1 - Managed care and children's behavioral health services in Massachusetts
T2 - Psychiatric services (Washington, D.C.)
TI - Managed care and children's behavioral health services in Massachusetts
U1 - Financing & Sustainability; Healthcare Policy
U2 - 11157116
VL - 52
VO - 1075-2730; 1075-2730
Y1 - 2001
ER -