title: How did the introduction of managed care for the uninsured in Iowa affect the use of substance abuse services?
abstract: Concerns about access under managed care have been raised for vulnerable populations such as publicly funded patients with substance abuse problems. To estimate the effects of the Iowa Managed Substance Abuse Care Plan (IMSACP) on substance abuse service use by publicly funded patients, service use before and after IMSACP was compared; adjustments were made for changes in population sociodemographic and clinical characteristics. Between fiscal years 1994 and 1997, patient case mix was marked by a higher burden of illness and the use of inpatient, residential nondetox, outpatient counseling, and assessment services declined, while use of intensive outpatient and residential detox services increased. Findings were similar among women, children, and homeless persons. Thus, care moved away from high-cost inpatient settings to less costly venues. Without knowing the impact on treatment outcomes, these changes cannot be interpreted as improved provider efficiency versus simply cost containment and profit maximization.
authors.affiliation: UCLA Department of Medicine, Division of General Internal Medicine, Health Services Research, 911 Broxton Plaza, Room 106, Los Angeles, CA 90095, USA. settner@mednet.ucla.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Milton
authors.initials: M
authors.lastname: Argeriou
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.forename: Joan
authors.initials: J
authors.lastname: Dilonardo
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
mesh_terms: D003628:Database Management Systems; D003953:Diagnosis-Related Groups; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007484:Iowa; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration*; D017057:Medically Uninsured; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D013221:State Health Plans / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D014481:United States