TY - VIDEO
KW - Financing
KW - Health care
KW - Medicaid
KW - Mental depression
KW - Mental Health
KW - primary care
KW - Public Health
KW - Studies
AU - Ashley Caroline Aull Dunham
A1 - 
AB - This dissertation uses mixed methods to test how primary care physicians altered depression treatment in the presence of a carve-out that precluded reimbursement for primary care mental health treatment. The context is the importance currently ascribed to primary care and its ethos of treating the "whole" patient, which conflicts with the deep-rooted practice of separating mental and somatic health. The new information generated by this research leads to a new conceptual framework for understanding primary care, one that accords equal importance to both rental and somatic health. Using a quasi-experimental design, difference-in-difference and logit models revealed an increase in primary care physician referrals to mental health providers with no change in primary care physician antidepressant prescribing post mental health carve-out. This information supported the principal-agent theory of economics as a better predictor of physician behavior than wealth maximization. Referrals to mental health providers did indicate that some primary care physicians limited the amount of time spent on mental health issues, thereby attempting to maximize their own wealth. Qualitative interviews with 20 primary care physicians provided valuable information regarding their interpretation of Medicaid policy and mental health reimbursement, their willingness to serve as advocates for their Medicaid patients by treating both mental and somatic health, and barriers that prevent them from serving as an advocate for the nonvolunatry Medicaid client. Lipsky's theory of street-level bureaucracy provided a framework on which to interpret the results.
C4 - This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.
C5 - Financing & Sustainability;Healthcare Policy; Financing & Sustainability; Healthcare Policy; Medically Unexplained Symptoms; Grey Literature
CY - United States -- North Carolina
N2 - This dissertation uses mixed methods to test how primary care physicians altered depression treatment in the presence of a carve-out that precluded reimbursement for primary care mental health treatment. The context is the importance currently ascribed to primary care and its ethos of treating the "whole" patient, which conflicts with the deep-rooted practice of separating mental and somatic health. The new information generated by this research leads to a new conceptual framework for understanding primary care, one that accords equal importance to both rental and somatic health. Using a quasi-experimental design, difference-in-difference and logit models revealed an increase in primary care physician referrals to mental health providers with no change in primary care physician antidepressant prescribing post mental health carve-out. This information supported the principal-agent theory of economics as a better predictor of physician behavior than wealth maximization. Referrals to mental health providers did indicate that some primary care physicians limited the amount of time spent on mental health issues, thereby attempting to maximize their own wealth. Qualitative interviews with 20 primary care physicians provided valuable information regarding their interpretation of Medicaid policy and mental health reimbursement, their willingness to serve as advocates for their Medicaid patients by treating both mental and somatic health, and barriers that prevent them from serving as an advocate for the nonvolunatry Medicaid client. Lipsky's theory of street-level bureaucracy provided a framework on which to interpret the results.
PB - The University of North Carolina at Charlotte
PP - United States -- North Carolina
PY - 2006
SP - 174
EP - 174
EP - 
T1 - Primary care and mental health: Does the financing and organization of health care affect the treatment of depression?
TI - Primary care and mental health: Does the financing and organization of health care affect the treatment of depression?
U1 - Financing & Sustainability;Healthcare Policy; Financing & Sustainability; Healthcare Policy; Medically Unexplained Symptoms; Grey Literature
U4 - This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.
VL - Ph.D.
Y1 - 2006
ER -