title: Outcomes for clients of public substance abuse treatment programs before and after Medicaid managed care.
abstract: Following conversion of Medicaid substance abuse treatment programs in Oregon from fee-for-service to managed care, there were suggestions of poorer outcomes. This project interviewed cohorts of Medicaid and non-Medicaid substance abuse treatment clients before and after the 1995 implementation of Oregon's Medicaid capitated payment system. Subjects were 553 adults (59% male, average age 35, 64% white). Forty-three percent were Medicaid clients and 60% were treated during the fee-for-service era. All clients were interviewed with the Addiction Severity Index at baseline and at 6 and 12 months thereafter. Multilevel, multivariate analyses examined baseline and outcome differences between the Medicaid and Non-Medicaid groups; between the fee-for-service and managed care conditions; and their interactions. After adjustment for covariates, most analyses were not statistically significant. It does not appear that Medicaid managed care had an adverse impact on outcomes for clients with substance abuse problems.
authors.affiliation: Department of Psychiatry, Oregon Health & Science University, Portland, OR 97329, USA. mcfarlab@ohsu.edu
authors.forename: Bentson H
authors.initials: BH
authors.lastname: McFarland
authors.forename: Lynn E
authors.initials: LE
authors.lastname: McCamant
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Barron
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology / Q000534:rehabilitation*; D002204:Capitation Fee / Q000706:statistics & numerical data; D015897:Comorbidity; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008016:Life Change Events; D008329:Managed Care Programs; D008484:Medicaid; D008875:Middle Aged; D009922:Oregon; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000534:rehabilitation*; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D014481:United States; D014492:United States Public Health Service; D014754:Violence / Q000517:prevention & control / Q000706:statistics & numerical data*; D014932:Women's Health Services / Q000706:statistics & numerical data*