Privatized Medicaid managed care in Massachusetts: disposition in child and adolescent mental health emergencies.
Data from child and adolescent emergency mental health screening episodes prior and subsequent to privatized Medicaid managed care in Massachusetts are used to investigate the relationship between payer source and disposition and to compare the match between clinical need and disposition level of care. Having Medicaid as the payer in the post-Medicaid managed care period decreased the odds of hospitalization by nearly 60%. None of the clinical need variables that contributed to hospitalization for Medicaid episodes in the pre-Medicaid managed care period were significant in the post-Medicaid managed care period. Multiple forces shaping professional standards, decision making, and quality of care are described. Public sector agencies must lay the groundwork for comprehensive evaluation prior to the implementation of privatized Medicaid managed care initiatives.
Department of Psychiatry, University of Massachusetts Medical School, Worcester 01655, USA. jnicholson@banyan.ummed.edu
J
J
Nicholson
S D
SD
Young
L J
LJ
Simon
W H
WH
Fisher
A
A
Bateman
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D004637:Emergency Services, Psychiatric / Q000458:organization & administration*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008403:Mass Screening; D008404:Massachusetts; D008484:Medicaid / Q000458:organization & administration*; D008605:Mental Health Services / Q000458:organization & administration*; D018579:Patient Selection; D011332:Privatization / Q000458:organization & administration*; D011635:Public Health Administration; D011787:Quality of Health Care; D014481:United States