title: The impact of managed care on cross-system use of mental health services by veterans in Colorado.
abstract: OBJECTIVE
  Some state mental health systems have implemented capitated managed care as a strategy for lowering mental health care costs. There has been concern that this strategy has left vulnerable populations at risk of not being able to obtain adequate care. This study examined whether the advent of managed care in Colorado resulted in lower rates of use of both state and Department of Veterans Affairs (VA) mental health care services (cross-system use).
  
  
  METHODS
  A cohort of 10,950 veterans who had used VA mental health services between 1995 and 1997 were studied to determine whether veterans who lived in counties that had implemented managed care were less likely to be cross-system users over time. VA data were matched with state mental health data to determine who was using both types of services.
  
  
  RESULTS
  Rates of cross-system use were generally low. Veterans who lived in a county that had implemented managed care were less likely to be cross-system users than veterans who lived in other counties. However, the proportions of cross system users in managed care counties and in other counties did not change significantly over time. Veterans who were cross-system users were more likely to be younger, to live farther away from a VA hospital and closer to a non-VA hospital, and to have received inpatient VA care.
  
  
  CONCLUSIONS
  The implementation of managed care in Colorado did not appear to have affected rates of cross-system use of state and VA mental health care.
authors.affiliation: Northeast Program Evaluation Center (NEPEC)/182, Department of Veterans Affairs, 950 Campbell Avenue, West Haven, CT 06516, USA. desai@biomed.med.yale.edu
authors.forename: Rani A
authors.initials: RA
authors.lastname: Desai
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
mesh_terms: D003120:Colorado; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D001523:Mental Disorders / Q000191:economics / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D014728:Veterans / Q000523:psychology*