A comparison of public and privatized approaches to managed behavioral health care for persons with serious mental illness.
This article compares public and privatized approaches to managed behavioral health care for persons with serious mental illness in Massachusetts. Data from the Department of Mental Health (DMH) for 247 patients receiving care managed by DMH and 312 in a Medicaid carve-out were compared. Repeated measures multivariate analysis of variance models were used to examine adjusted changes in number of admissions, bed days, and facilities used from a baseline year before program implementation in 1992 through two follow-up years. Results were comparable for the two programs with similar reductions in the number of people receiving inpatient care but increases in admissions and bed days. Possible problems with continuity of care, indicated by individuals using multiple facilities, were identified for both. Given the evidence of comparable results, the choice between the two approaches is likely to be dictated by various pragmatic and subjective factors other than their demonstrated effectiveness.
John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts, USA.
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Wieman
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Dorwart
D000328:Adult; D000368:Aged; D001521:Behavior Therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008404:Massachusetts; D008484:Medicaid; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011332:Privatization / Q000706:statistics & numerical data; D017150:Public Sector / Q000706:statistics & numerical data; D014600:Utilization Review