title: Service use and health status of persons with severe mental illness in full-risk and no-risk medicaid programs.
abstract: OBJECTIVE
  The service use patterns and health status outcomes of Medicaid recipients with severe mental illness in a system that assigned full financial risk to managed care organizations through capitation and a system that paid for mental health care on a no-risk fee-for-service basis were compared.
  
  
  METHODS
  With use of a quasi-experimental design, initial interviews (time 1) and follow-up interviews six months later (time 2) were conducted among 92 clients in the full-risk group and 112 clients in the no-risk group. Regression models were used to compare self-reported service use and health status between the two groups.
  
  
  RESULTS
  Service use patterns differed between the two groups. When symptom severity at time 1 was controlled for, clients in the full-risk group were more likely to have received case management but less likely to report contact with a psychiatrist or to have received counseling than clients in the no-risk group. When health status at time 1 was controlled for, clients in the full-risk group reported poorer mental health at time 2 than clients in the no-risk group. When physical health status at time 1 was controlled for, clients in the full-risk group reported poorer physical health at time 2 than clients in the no-risk group.
  
  
  CONCLUSIONS
  Capitation was associated with lower use of costly services. Clients with serious mental illness in the full-risk managed care system had poorer mental and physical health outcomes than those in the no-risk system.
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 27599-7590, USA. joe_morrissey@unc.edu
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Morrissey
authors.forename: T Scott
authors.initials: TS
authors.lastname: Stroup
authors.forename: Alan R
authors.initials: AR
authors.lastname: Ellis
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Merwin
mesh_terms: D000328:Adult; D002204:Capitation Fee; D018588:Fee-for-Service Plans; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008484:Medicaid / Q000458:organization & administration* / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D020414:Risk Sharing, Financial; D012720:Severity of Illness Index; D014481:United States; D014600:Utilization Review