The impact of managed care on the substance abuse treatment patterns and outcomes of Medicaid beneficiaries: Maryland's HealthChoice program.
The introduction of Medicaid managed care raises concern that profit motives lead to the undersupply of substance abuse (SA) services. To test effects of the Maryland Medicaid HealthChoice program on SA treatment patterns and outcomes, Medicaid eligibility files were linked to treatment provider records and two study designs were used to estimate program impact: a quasi-experimental design with matched comparison groups and a natural experiment. Patient sociodemographic and clinical characteristics were adjusted using multiple regression. Under managed care, there was a shift from residential, correctional-only, and detoxification-only treatment toward outpatient-only treatment. Among beneficiaries entering treatment, those enrolled in managed care organizations (MCOs) had similar utilization and outcomes to those in Medicaid fee-for-service; those enrolling in MCOs during treatment had longer and more intensive episodes and, as a result, better outcomes. Thus, the study disclosed no empirical evidence that health plans respond to capitation by reducing SA services.
Ettner
Susan L
SL
UCLA Department of Medicine, Division of General Internal Medicine & Health Services Research, 911 Broxton Plaza, Room 106, Box 951736, Los Angeles, CA 90095-1736, USA. settner@mednet.ucla.edu
Denmead
Gabrielle
G
Dilonardo
Joan
J
Cao
Hui
H
Belanger
Albert J
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D004608:Eligibility Determination; D005260:Female; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage; D008329:Managed Care Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D008396:Maryland; D008484:Medicaid / Q000458:organization & administration*; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D015397:Program Evaluation; D013221:State Health Plans; D019966:Substance-Related Disorders / Q000191:economics / Q000208:ethnology / Q000534:rehabilitation*; D016896:Treatment Outcome; D014481:United States