Psychiatric service utilization and cost for persons with schizophrenia in a Medicaid managed care program.
A pre-post study design was used to look at changes in behavioral health care services and costs for Medicaid-eligible individuals with schizophrenia in a managed care (MC) carve-out compared to a fee-for-service (FFS) program in Pennsylvania between 1995 and 1998. Statistically significant reductions of 59% were found in hospital expenditures in the MC program compared to 18.3% in the FFS program. The decline in hospital costs was due to dramatic fee reductions in the MC site. No significant differences in overall ambulatory utilization were found in either program; however, ambulatory expenditures rose 57% in the MC program versus a decline of 11% in fee for service. The ambulatory cost increase resulted from a cost shift between county block grant funds, and Medicaid funds, with no additional revenues provided to outpatient providers. Study implications are that cost reductions from MC are mainly due to reducing utilization and payments to hospitals, similar to the findings for private sector programs.
Rothbard
Aileen B
AB
School of Social Work, and the Center for Mental Health Policy and Services Research, Department of Psychiatry, University of Pennsylvania, Medical Center, 3535 Market St, Rm 3014, Philadelphia, PA 19104, USA. rothbard@mail.med.upenn.edu
Kuno
Eri
E
Hadley
Trevor R
TR
Dogin
Judith
J
D000328:Adult; D017831:Diagnosis, Dual (Psychiatry) / Q000191:economics; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008484:Medicaid / Q000191:economics*; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D010414:Pennsylvania; D011567:Psychiatric Department, Hospital / Q000191:economics / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000150:complications / Q000191:economics* / Q000628:therapy; D013221:State Health Plans / Q000191:economics*; D019966:Substance-Related Disorders / Q000150:complications / Q000191:economics / Q000628:therapy; D014481:United States