Changes in access to mental health care among the poor and nonpoor: results from the health care reform in Puerto Rico.
OBJECTIVE
Health care reforms associated with managed care may adversely affect the health care safety net for disadvantaged populations. This study compared changes in health care use among poor and nonpoor individuals enrolled in managed care.


METHODS
Data from 3 waves of a random community sample were collected on approximately 3,000 adults. Changes in use of mental health services were assessed in a pretest-posttest, quasi-experimental design.


RESULTS
Managed care increased use of specialty services among the nonpoor while maintaining the same level of use for the poor in the public sector.


CONCLUSIONS
Reallocation of mental health services may be a result of expanding Medicaid eligibility.
Alegría
M
M
Graduate School of Public Health, University of Puerto Rico, San Juan 00936-5067, USA. malegria@rcm.upr.edu
McGuire
T
T
Vera
M
M
Canino
G
G
Matías
L
L
Calderón
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018166:Health Care Reform / Q000458:organization & administration*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D009936:Organizational Innovation; D011203:Poverty / Q000706:statistics & numerical data*; D015397:Program Evaluation; D017150:Public Sector; D011647:Puerto Rico; D011795:Surveys and Questionnaires