title: The impact of managed care on the use of outpatient mental health and substance abuse services in Puerto Rico.
abstract: This paper estimates the impact of managed care on use of mental health services by residents of low-income areas in Puerto Rico. A quasi-experimental design evaluates the impact of a low capitation rate on a minority population using three waves of data from a random community sample. Results indicate that two years after introducing managed care, privatization of mental health services had minimal impact on use. Advocates had hoped health care reform would increase access in comparison to access seen within the public system, while opponents feared profit motives would lead to decreased access. Neither forecast turned out to be correct. The question remains as to how to improve access for the poor with low capitation rates.
authors.affiliation: Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, San Juan 00936-5067, USA.
authors.forename: M
authors.initials: M
authors.lastname: Alegría
authors.forename: T
authors.initials: T
authors.lastname: McGuire
authors.forename: M
authors.initials: M
authors.lastname: Vera
authors.forename: G
authors.initials: G
authors.lastname: Canino
authors.forename: D
authors.initials: D
authors.lastname: Freeman
authors.forename: L
authors.initials: L
authors.lastname: Matías
authors.forename: C
authors.initials: C
authors.lastname: Albizu
authors.forename: H
authors.initials: H
authors.lastname: Marín
authors.forename: J
authors.initials: J
authors.lastname: Calderón
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002204:Capitation Fee; D003156:Community Mental Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D003284:Contract Services / Q000458:organization & administration*; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000458:organization & administration; D006302:Health Services Research; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D008484:Medicaid / Q000458:organization & administration*; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D011204:Poverty Areas; D011332:Privatization; D011647:Puerto Rico; D019966:Substance-Related Disorders / Q000628:therapy