Schizophrenia, Co-occurring Substance use Disorders and Quality of Care: The Differential Effect of a Managed Behavioral Health Care Carve-out

  • Alisa B. Busch
  • Richard G. Frank
  • Anthony F. Lehman
  • Shelly F. Greenfield
ORIGINAL PAPER

Abstract

This study explores the differential effect of a managed behavioral health Carve-Out (CO) on outpatient treatment quality for persons with schizophrenia (SCHZ) alone and co-occurring substance use disorders (SUD) (SCHZ+SUD). We used claims data from a state Medicaid program and employed a retrospective, quasi-experimental design with logit and difference in difference formula regression models. The results show the CO was associated with greater changes in treatment quality for the SCHZ population, compared to the SCHZ+SUD population. Most pronounced across both populations were decrements in receiving the psychosocial treatments for enrollees in the CO arrangement.

Key words

Co-occurring disorders Schizophrenia Substance use disorders Quality of care Managed care 

Notes

Acknowledgements

We gratefully acknowledge funding from the NIMH (R01MH62028, R01MH62028: Drs. Busch and Frank; and R01MH59254: Dr. Frank), NIDA (K08 DA00407: Dr. Greenfield; 2 P50 DA10233-06A2: Drs. Frank and Greenfield), the McLean Hospital Maria Lorenz-Pope Award (Dr. Busch) and the National Center on Minority Health and Health Disparities (Dr. Busch). The funding organizations had no role in the collection, analysis or interpretation of the data. They also had no role in the preparation, review or approval of this manuscript. We also thank Christina Fu, Ph.D. for her programming expertise on this project.

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Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Alisa B. Busch
    • 1
  • Richard G. Frank
    • 2
  • Anthony F. Lehman
    • 3
  • Shelly F. Greenfield
    • 4
  1. 1.Alcohol and Drug Abuse Treatment Program and the Department of Health Care PolicyMcLean Hospital and Harvard Medical SchoolBelmontUSA
  2. 2.Department of Health Care PolicyHarvard Medical School and National Bureau of Economic ResearchBostonUSA
  3. 3.Department of PsychiatryUniversity of Maryland School of MedicineBaltimoreUSA
  4. 4.Alcohol and Drug Abuse Treatment ProgramMcLean Hospital and Harvard Medical SchoolBelmontUSA

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