title: Managed care and mental health: personal realities.
abstract: A review of the literature revealed mixed reviews on the impact of managed care on mental health service delivery. Research supports that managed care contributes to a reduction in inpatient costs and an increase in outpatient service use. Other studies suggest that there are problems with access and quality of care. An additional issue is whether or not, and to what extent, mental health services are "carved out" from physical health for patients. This study discusses the findings of a qualitative analysis of Medicaid managed care recipients on the barriers and enabling factors to obtaining mental health services in a full carve-out managed care model. Results indicate that reduced access, quality of care problems, and a lack of integration of care exist. Additionally, recipients' interactions with managed care, service providers, and caseworkers affect their mental health care. The results also report on the tactics used by recipients to cope with service problems. Implications for social work practice and research are discussed and recommendations for service delivery and evidence-based education are delineated.
authors.affiliation: University of Missouri-Columbia, School of Social Work, 65211-4470, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Galambos
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rocha
authors.forename: Andrea K
authors.initials: AK
authors.lastname: McCarter
authors.forename: Daryl
authors.initials: D
authors.lastname: Chansuthus
mesh_terms: D019090:Case Management; D003266:Continuity of Patient Care; D003669:Deductibles and Coinsurance; D005569:Formularies as Topic; D006297:Health Services Accessibility; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration* / Q000592:standards; D008484:Medicaid / Q000458:organization & administration* / Q000592:standards; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D017146:Models, Organizational; D011369:Professional-Patient Relations; D011619:Psychotropic Drugs / Q000600:supply & distribution; D011787:Quality of Health Care; D012017:Referral and Consultation; D012949:Social Work, Psychiatric / Q000193:education; D013221:State Health Plans; D011795:Surveys and Questionnaires; D013714:Tennessee; D014481:United States
chemical_list: D011619:Psychotropic Drugs