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The impact of managed care on the substance abuse treatment patterns and outcomes of medicaid beneficiaries: Maryland's health choice program

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Abstract

The introduction of Medicaid managed care raises concern that profit motives lead to the undersupply of substance abuse (SA) services. To test effects of the Maryland Medicaid HealthChoice program on SA treatment patterns and outcomes, Medicaid eligibility files were linked to treatment provider records and two study designs were used to estimate program impact: a quasi-experimental design with matched comparison groups and a natural experiment. Patient sociodemographic and clinical characteristics were adjusted using multiple regression. Under managed care, there was a shift from residential, correctional-only, and detoxification-only treatment toward outpatient-only treatment. Among beneficiaries entering treatment, those enrolled in managed care organizations (MCOs) had similar utilization and outcomes to those in Medicaid fee-for-service; those enrolling in MCOs during treatment had longer and more intensive episodes and, as a result, better outcomes. Thus, the study disclosed no empirical evidence that health plans respond to capitation by reducing SA services.

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Authors and Affiliations

  1. UCLA Department of Medicine, Division of General, Internal Medicine & Health Services Research, 911 Broxton Plaza, Room 106, Box 951736, 90095-1736, Los Angeles, CA

    Susan L. Ettner PhD (Associate Professor)

  2. Office of Quality Improvement and Financing, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, USA

    Joan Dilonardo PhD (Acting Branch Chief)

  3. Department of Economics, University of California, Los Angeles

    Hui Cao MA (Doctoral Student)

  4. Department of Health Care Policy, Harvard Medical School, USA

    Albert J. Belanger MA (Statistical Programmer)

Authors
  1. Susan L. Ettner PhD
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  2. Gabrielle Denmead
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  3. Joan Dilonardo PhD
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  4. Hui Cao MA
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  5. Albert J. Belanger MA
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Correspondence to Susan L. Ettner PhD.

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Denmead & Associates Consulting

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Ettner, S.L., Denmead, G., Dilonardo, J. et al. The impact of managed care on the substance abuse treatment patterns and outcomes of medicaid beneficiaries: Maryland's health choice program. The Journal of Behavioral Health Services & Research 30, 41–62 (2003). https://doi.org/10.1007/BF02287812

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