Service use and health status of persons with severe mental illness in full-risk and no-risk medicaid programs.

Published

Journal Article

OBJECTIVE: The service use patterns and health status outcomes of Medicaid recipients with severe mental illness in a system that assigned full financial risk to managed care organizations through capitation and a system that paid for mental health care on a no-risk fee-for-service basis were compared. METHODS: With use of a quasi-experimental design, initial interviews (time 1) and follow-up interviews six months later (time 2) were conducted among 92 clients in the full-risk group and 112 clients in the no-risk group. Regression models were used to compare self-reported service use and health status between the two groups. RESULTS: Service use patterns differed between the two groups. When symptom severity at time 1 was controlled for, clients in the full-risk group were more likely to have received case management but less likely to report contact with a psychiatrist or to have received counseling than clients in the no-risk group. When health status at time 1 was controlled for, clients in the full-risk group reported poorer mental health at time 2 than clients in the no-risk group. When physical health status at time 1 was controlled for, clients in the full-risk group reported poorer physical health at time 2 than clients in the no-risk group. CONCLUSIONS: Capitation was associated with lower use of costly services. Clients with serious mental illness in the full-risk managed care system had poorer mental and physical health outcomes than those in the no-risk system.

Full Text

Duke Authors

Cited Authors

  • Morrissey, JP; Stroup, TS; Ellis, AR; Merwin, E

Published Date

  • March 2002

Published In

Volume / Issue

  • 53 / 3

Start / End Page

  • 293 - 298

PubMed ID

  • 11875222

Pubmed Central ID

  • 11875222

Electronic International Standard Serial Number (EISSN)

  • 1557-9700

International Standard Serial Number (ISSN)

  • 1075-2730

Digital Object Identifier (DOI)

  • 10.1176/appi.ps.53.3.293

Language

  • eng