Cost shifting under managed behavioral health care.
OBJECTIVE
The study examined whether a managed behavioral health care organization (MBHO) shifted treatment costs.


METHODS
Four years of claims data (1991-1995) from an insurer that introduced an MBHO in 1992 to control treatment costs were analyzed. Although the MBHO was not at direct financial risk for specialty mental health treatment, it faced incentives related to reputation and contract renewal to shift costs to primary care treatment or prescription drugs. It was hypothesized that if cost shifting occurred, an increase would be noted in the use of psychotropic medications without concurrent use of specialty mental health treatment. Simple t tests and a generalized estimating equations probit specification were used to test this hypothesis. Separate tests were performed for use of any psychotropic medication, any newer antidepressant, and any stimulant in a large employer group that simultaneously implemented parity coverage (75,360 enrollees) and a group of smaller employers that did not (9,228 enrollees).


RESULTS
The use of any psychotropic medication rose 64% in relative terms (p<.001) over the four-year period among enrollees of the large employer group and by 87% in the smaller groups (p<.001). In general, there were downward secular trends in the use of psychotropic medications without specialty care. Introduction of the MBHO was not significantly associated with the use of psychotropic medication alone. For newer antidepressants, introduction of the MBHO was associated in the large group with a 2.4 (p=.003) absolute percentage point decrease in medication use alone.


CONCLUSIONS
No evidence was found to suggest that the MBHO shifted treatment costs.
Zuvekas
Samuel H
SH
Center for Financing Access and Cost Trends, Agency for Healthcare Research and Quality, 540 Gaither Rd., Rockville, MD 20850, USA. szuvekas@ahrq.gov
Rupp
Agnes
A
Norquist
Grayson
G
D000328:Adult; D003361:Cost Allocation; D003362:Cost-Benefit Analysis; D004358:Drug Therapy / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics* / Q000458:organization & administration*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics* / Q000458:organization & administration*; D014481:United States