Abstract
OBJECTIVES: This study tested 2 propositions concerning the effect of capitated financing on mental health services for Medicaid-eligible children and youth in Colorado. The first is that capitation reduces costs. The second is that shifting providers from fee-for-service to capitated financing will increase their efforts to prevent illness. METHODS: Interrupted time-series designs were applied to a naturally occurring quasi experiment occasioned by the state of Colorado's reorganization of mental health services financing. RESULTS: The cost of services was significantly lower in counties with capitated services compared with counties with fee-for-service financing. Findings also suggested that economic incentives may lead to greater efforts at secondary and tertiary prevention. CONCLUSIONS: Policymakers and the public can expect that capitation will reduce the costs of children's mental health services below those likely with fee-for-service financing. Capitation per se, however, may not increase prevention as surely or swiftly as it lowers costs.
Full Text
The Full Text of this article is available as a PDF (81.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bloom Joan R., Hu Tw Teh-wei, Wallace Neal, Cuffel Brian, Hausman Jackie, Scheffler Richard. Mental health costs and outcomes under alternative capitation systems in Colorado: early results. J Ment Health Policy Econ. 1998 Mar;1(1):3–13. doi: 10.1002/(sici)1099-176x(199803)1:1<3::aid-mhp4>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
- Burns B. J., Teagle S. E., Schwartz M., Angold A., Holtzman A. Managed behavioral health care: a Medicaid carve-out for youth. Health Aff (Millwood) 1999 Sep-Oct;18(5):214–225. doi: 10.1377/hlthaff.18.5.214. [DOI] [PubMed] [Google Scholar]
- Catalano R., Serxner S. Time series designs of potential interest to epidemiologists. Am J Epidemiol. 1987 Oct;126(4):724–731. doi: 10.1093/oxfordjournals.aje.a114712. [DOI] [PubMed] [Google Scholar]
- Chandler D., Hu T. W., Meisel J., McGowen M., Madison K. Mental health costs, other public costs, and family burden among mental health clients in capitated integrated service agencies. J Ment Health Adm. 1997 Spring;24(2):178–188. doi: 10.1007/BF02898512. [DOI] [PubMed] [Google Scholar]
- Christianson J. B., Manning W., Lurie N., Stoner T. J., Gray D. Z., Popkin M., Marriott S. Utah's Prepaid Mental Health Plan: the first year. Health Aff (Millwood) 1995 Fall;14(3):160–172. doi: 10.1377/hlthaff.14.3.160. [DOI] [PubMed] [Google Scholar]
- Elliott R. L. Patient dumping, COBRA, and the public psychiatric hospital. Hosp Community Psychiatry. 1993 Feb;44(2):155–158. doi: 10.1176/ps.44.2.155. [DOI] [PubMed] [Google Scholar]
- Frank R. G., McGuire T. G. Savings from a Medicaid carve-out for mental health and substance abuse services in Massachusetts. Psychiatr Serv. 1997 Sep;48(9):1147–1152. doi: 10.1176/ps.48.9.1147. [DOI] [PubMed] [Google Scholar]
- Kovacs M. Presentation and course of major depressive disorder during childhood and later years of the life span. J Am Acad Child Adolesc Psychiatry. 1996 Jun;35(6):705–715. doi: 10.1097/00004583-199606000-00010. [DOI] [PubMed] [Google Scholar]
- Loeber R., Hay D. Key issues in the development of aggression and violence from childhood to early adulthood. Annu Rev Psychol. 1997;48:371–410. doi: 10.1146/annurev.psych.48.1.371. [DOI] [PubMed] [Google Scholar]
- Ma C. A., McGuire T. G. Costs and incentives in a behavioral health carve-out. Health Aff (Millwood) 1998 Mar-Apr;17(2):53–69. doi: 10.1377/hlthaff.17.2.53. [DOI] [PubMed] [Google Scholar]
- Nicholson J., Young S. D., Simon L., Bateman A., Fisher W. H. Impact of Medicaid managed care on child and adolescent emergency mental health screening in Massachusetts. Psychiatr Serv. 1996 Dec;47(12):1344–1350. doi: 10.1176/ps.47.12.1344. [DOI] [PubMed] [Google Scholar]
- Norton E. C., Lindrooth R. C., Dickey B. Cost shifting in a mental health carve-out for the AFDC population. Health Care Financ Rev. 1997 Spring;18(3):95–108. [PMC free article] [PubMed] [Google Scholar]
- Sabin J. E., Daniels N. Public-sector managed behavioral health care: II. Contracting for Medicaid services--the Massachusetts experience. Psychiatr Serv. 1999 Jan;50(1):39–41. doi: 10.1176/ps.50.1.39. [DOI] [PubMed] [Google Scholar]
- Scholle S. H., Kelleher K. J., Childs G., Mendeloff J., Gardner W. P. Changes in Medicaid managed care enrollment among children. Health Aff (Millwood) 1997 Mar-Apr;16(2):164–170. doi: 10.1377/hlthaff.16.2.164. [DOI] [PubMed] [Google Scholar]
- Shern D. L., Donahue S. A., Felton C., Joseph G. R., Brier N. Partial capitation versus fee-for-service in mental health care. Health Aff (Millwood) 1995 Fall;14(3):208–219. doi: 10.1377/hlthaff.14.3.208. [DOI] [PubMed] [Google Scholar]
- Stoner T., Manning W., Christianson J., Gray D. Z., Marriott S. Expenditures for mental health services in the Utah Prepaid Mental Health Plan. Health Care Financ Rev. 1997 Spring;18(3):73–93. [PMC free article] [PubMed] [Google Scholar]
- Stroul B. A., Pires S. A., Roebuck L., Friedman R. M., Barrett B., Chambers K. L., Kershaw M. A. State health care reforms: how they affect children and adolescents with emotional disorders and their families. J Ment Health Adm. 1997 Fall;24(4):386–399. doi: 10.1007/BF02790502. [DOI] [PubMed] [Google Scholar]
- Stroup T. S., Dorwart R. A. Impact of a managed mental health program on Medicaid recipients with severe mental illness. Psychiatr Serv. 1995 Sep;46(9):885–889. doi: 10.1176/ps.46.9.885. [DOI] [PubMed] [Google Scholar]
- Zhang M., Lancaster B., Clardy J. A., Smith G. R., Jr Mental health capitation for children and adolescents under Medicaid. Psychiatr Serv. 1999 Feb;50(2):189–191. doi: 10.1176/ps.50.2.189. [DOI] [PubMed] [Google Scholar]