Mental Health Services Research

, Volume 2, Issue 1, pp 13–25 | Cite as

Refining the Costs Analyses of the Fort Bragg Evaluation: The Impact of Cost Offset and Cost Shifting

  • E. Michael Foster
  • Leonard Bickman
Article

Abstract

A key aim of the evaluation of the Fort Bragg Demonstration was to determine whether delivering services through a continuum of care lowered expenditures on mental health services. The evaluation clearly showed that expenditures were actually higher in the Demonstration. Critics of the evaluation claimed that the evaluation's perspective on costs was too narrow—in particular, that the Demonstration produced cost shifting and cost offset that were not captured by the evaluation. New data allow us to include a broader array of costs: mental health services received outside the catchment areas, general medical services for the children themselves, and mental health services used by family members. Results showed that reductions in other costs do partially offset higher expenditures on mental health services for children at the Fort Bragg Demonstration. However, even when broader costs are included, total family expenditures are still substantially higher at the Demonstration.

costs children evaluation 

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REFERENCES

  1. Achenbach, T. M. (1991). Manual for the Child Behavior Checklist and 1991 profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  2. Bickman, L. (1996). A continuum of care: More is not always better. American Psychologist, 51(7), 689-701.Google Scholar
  3. Bickman, L., Guthrie, P. R., Foster, E. M., Lambert, E. W., Summerfelt, W. T., Breda, C., & Heflinger, C. (1995). Managed care in mental health: The Fort Bragg Experiment. New York: Plenum.Google Scholar
  4. Budman, S. H., Demby, A. B., & Feldstein, M. L. (1984). A controlled study of the impact of mental health treatment on medical care utilization. Medical Care, 22(3), 216-222.Google Scholar
  5. Burke, K. C., Meek, W. J., Krych, R., Nisbet, R., & Burke, J. D., Jr. (1995). Medical services used by patients before and after detoxification from benzodiazepine dependence. Psychiatric Services, 46(2), 157-160.Google Scholar
  6. Duan, N., Manning, W. G., Morris, C. N., & Newhouse, J. P. (1982). A comparison of alternative models for the demand for medical care. Rand Report R-2754-HHS. Santa Monica, CA: Rand Corporation.Google Scholar
  7. Foster, E. M., & Bickman, L. (1997). Final report: Refining the cost-effectiveness analyses from the final report of the outcome&cost/utilization studies of the Fort Bragg Evaluation. Nashville, TN: Center for Mental Health Policy, Vanderbilt University.Google Scholar
  8. Foster, E. M., Summerfelt, W. T., & Saunders, R. (1996). The costs of mental health services under the Fort Bragg Demonstration. Journal of Mental Health Administration, 23, 92-106.Google Scholar
  9. Goldberg, I. D., Krantz, G., & Locke, B. Z. (1970). Effect of shortterm outpatient psychiatric therapy benefit on the utilization of medical services in a prepaid group practice medical program. Medical Care, 8(5), 419-428.Google Scholar
  10. Goldensohn, S. S., & Fink, R. (1979). Mental health services for Medicaid enrollees in a prepaid group practice plan. American Journal of Psychiatry, 136(2), 160-164.Google Scholar
  11. Hodges, K., & Gust, J. (1995). Measures of impairment for children and adolescents. Journal of Mental Health Administration, 22, 403-413.Google Scholar
  12. Hodges, K., Kline, J., Stern, L., Cytryn, L., & McKnew, D. (1982). The development of a child assessment interview for research and clinical use. Journal of Abnormal Child Psychology, 17, 691-701.Google Scholar
  13. Hodges, K., & Wong, M. M. (1997). Use of the Child and Adolescent Functional Assessment Scale to predict service utilization and cost. Journal of Mental Health Administration, 24, 278-290.Google Scholar
  14. Lagenbucher, J. (1994). Offsets are not add-ons: The place of additions treatment in American health care reform. Journal of Substance Abuse, 6, 117-122.Google Scholar
  15. Manning, W. (1998). The logged dependent variable, heteroskedasticity, and the retransformation problem. Journal of Health Economics, 17, 283-295.Google Scholar
  16. Massad, P. M., West, A. N., & Friedman, M. J. (1990). Relationship between utilization of mental health and medical services in a VAhospital. American Journal of Psychiatry, 147(4), 465-469.Google Scholar
  17. Mumford, E., & Schlesinger, H. J. (1987). Assessing consumer benefit. Cost offset as an incidental effect of psychotherapy. General Hospital Psychiatry, 9(5), 360-363.Google Scholar
  18. Mumford, E., Schlesinger, H., Glass, G. V., Patrick, C., & Cuerdon, T. (1984). A new look at evidence about reduced cost of medical utilization following mental health treatment. American Journal of Psychiatry, 141(10), 1145-1158.Google Scholar
  19. Norton, E., Lindrooth, R., & Dickey, B. (1997). Cost shifting in a mental health carve-out for the AFDC population. Health Care Financing Review, 18(3), 95-108.Google Scholar
  20. Olfson, M., Sing, M., & Schlesinger, H. J. (1999). Mental health/medical care cost offsets: Opportunities for managed care. Health Affairs, 18(2), 79-90.Google Scholar
  21. Pires, S. (1997). Lessons learned from the Fort Bragg Demonstration: An overview. In S. Pires (Ed.), Lessons learned from the Fort Bragg Demonstration (pp. 1-21). Tampa, FL: Louis de la Parte Florida Mental Health Institute.Google Scholar
  22. Reich, W., & Welner, Z. (1990). Interview for Children and Adolescents-Revised Child version DICA-R-C (DSM-III-R version). St. Louis, MO: Division of Child Psychiatry, Washington University.Google Scholar
  23. Schafer, J. L. (1997). Analysis of incomplete multivariate data. New York: Chapman and Hall.Google Scholar
  24. Schaffer, D., Fister, P., Piacentini, J., Schwab, C., Stone, M., &Wicks, J. (1989). Diagnostic Interview Schedule for Children: DISC-2.1C, Child Version. Unpublished manuscript. Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute.Google Scholar
  25. Schaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., & Aluwhalia, S. (1983). A Children's Global Assessment Scale (CGAS). Archives of General Psychiatry, 40, 1228-1231.Google Scholar
  26. Shemo, J. P. (1985). Cost-effectiveness of providing mental health services: The offset effect, International Journal of Psychiatry in Medicine, 15(1), 19-30.Google Scholar
  27. Simon, G. E., & Katzelnick, D. J. (1997). Depression, use of medical services and cost-offset effects. Journal of Psychosomatic Research, 42, 333-344.Google Scholar
  28. Strain, J. J., Hamner, J. S., & Fulop, G. (1994). APM task force on psychosocial interventions in the general hospital inpatient setting. Psychosomatics, 35(3), 253-262.Google Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • E. Michael Foster
    • 1
  • Leonard Bickman
    • 2
  1. 1.School of Policy StudiesGeorgia State UniversityAtlanta
  2. 2.Center for Mental Health PolicyVanderbilt UniversityNashville

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