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Children's use of mental health services in different Medicaid insurance plans

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Abstract

This study examined the effect of different Medicaid insurance plans on children's mental health service use through survey, claims, and encounter data collected between February 1998 and February 1999. Participants were assigned to 1 of 3 insurance plans: fee-for-service, a Health Maintenance Organization and prepaid carve-out. Logistic and stratified logistic regression were used to examine the effect of plan on service utilization, adjusting for caregiver report of need for services and psychosocial functioning. There was no difference in service use by plan controlling for demographic characteristics; however, when psychopathology and caregiver report of need for services were included in the model, the odds of using services in the Health Maintenance Organization was half of and the odds in the carve-out 29% less than the odds of using services in fee-for-service. Characteristics of the interaction between need, psychopathology, and insurance plan that may be associated with the reduction in service use are discussed.

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References

  1. McCormick M, Kass B, Elixhauser A, et al. Annual report on access to and utilization of health care for children and youth in the United States—1999.Pediatrics. 2000;105(1):219–230.

    Google Scholar 

  2. Szilagyi P. Managed care for children: effect on access to care and utilization of health services.Future of Children. 1998;8(2):39–59.

    Google Scholar 

  3. Fox H, Wicks L, Newacheck P. Health maintenance organizations and children with special needs. A suitable match.American Journal of Diseases of Children. 1993;147:546–552.

    Google Scholar 

  4. Horowitz S, Stein R. Health maintenance organizations versus indemnity insurance for children with chronic illnesses.American Journal of Diseases of Children. 1990;144:581–586.

    Google Scholar 

  5. Szilagyi P, Schor E. The health of children.Health Services Research. 1998;33(4):1001–1039.

    Google Scholar 

  6. Dubay L, Kenney G. Health care access and use among low-income children: who fairs best.Health Affairs. 2001;20(1):112–121.

    Google Scholar 

  7. Mauldon J, Leibowitz A, Buchanan J, et al. Rationing or rationalizing children's medical care: comparison of a Medicaid HMO with fee-for-service care.American Journal of Public Health. 1994;84(6):899–904.

    Google Scholar 

  8. Norquist G, Wells K. How do HMOs reduce outpatient mental health care costs.American Journal of Psychiatry. 1991;148(1):96–101.

    Google Scholar 

  9. Sturm R. How does risk sharing between employers and a managed behavioral health organization affect mental health care.Health Services Research. 2000;35(4):761–776.

    Google Scholar 

  10. Manning W, Wells K, Benjamin B. Use of outpatient mental health services over time in a health maintenance organization and fee-for-service plans.American Journal of Psychiatry. 1987;144(3):283–287.

    Google Scholar 

  11. Dickey B, Normand S, Norton E, et al. Managed care and children's behavioral health services in Massachusetts.Psychiatric Services. 2001;52(2):183–188.

    Google Scholar 

  12. Goldman W, McCulloch J, Sturm R. Costs and use of mental health services before and after managed care.Health Affairs. 1998;17(2):40–52.

    Google Scholar 

  13. Grazier K, Eselius L, Hu T, et al. Effects of a mental health carve-out on use, costs and payers: a four-year study.Journal of Behavioral Health Services & Research. 1999;26(4):381–389.

    Google Scholar 

  14. Stroul B, Pires S, Armstrong M, et al. The impact of managed care on mental health services for children and their families.The Future of Children. 1998;8(2):119–133.

    Google Scholar 

  15. Pires S, Stroul B, Armstrong M.Health Care Reform Tracking Project: Tracking State Managed Care Reforms as They Affect Children and Adolescents With Behavioral Health Disorders and Their Families. Tampa, Fla: Louis de la Parte Mental Health Institute, University of South Florida; 2000.

    Google Scholar 

  16. Mark T, Mueller C. Access to care in HMOs and traditional insurance plans.Health Affairs. 1996;15(4):81–87.

    Google Scholar 

  17. Pina D. Medicaid beneficiaries' experiences in HMO and fee-for-service health care.Journal of Health Care for the Poor and Underserved. 1998;9(4):433–448.

    Google Scholar 

  18. Hurley R, Freund D, Paul J.Managed Care in Medicaid: Lessons for Policy and Program Design. Ann Arbor, Mich: Health Administration Press; 1993.

    Google Scholar 

  19. Sturm R, Jackson C, Meredith L, et al. Mental health care utilization in prepaid and fee-for-service plans among depressed patients in the Medical Outcomes Study.Health Services Research. 1995;30(2):319–340.

    Google Scholar 

  20. Manning W, Liu C, Stoner T, et al. Outcomes for Medicaid beneficiaries with schizophrenia under a prepaid mental health carve-out.Journal of Behavioral Health Services & Research. 1999;26(4):442–450.

    Google Scholar 

  21. Liu X, Sturm R, Cuffel B. The impact of prior authorization on outpatient utilization.Medical Care Research and Review. 2000;57(2):182–195.

    Google Scholar 

  22. Wu P, Hoven C, Bird H, et al. Depressive and disruptive disorders and mental health service utilization in children and adolescents.Journal of the American Academy of Child and Adolescent Psychiatry. 1999;38(9):1081–1090.

    Google Scholar 

  23. Verhulst F, van der Ende J. Factors associated with child mental health service use in the community.Journal of the American Academy of Child and Adolescent Psychiatry. 1997;36(7):901–909.

    Google Scholar 

  24. Fendrich M, Johnson T, Wislar J, et al. Accuracy of parent mental health service reporting: results from a reverse record-check study.Journal of the American Academy of Child and Adolescent Psychiatry. 1999;38(2):147–155.

    Google Scholar 

  25. Leaf P, Alegria M, Cohen P, et al. Mental health service use in the community and schools: results from the four-community MECA Study: Methods for the Epidemiology of Child and Adolescent Mental Disorders Study.Journal of the American Academy of Child and Adolescent Psychiatry. 1996;35(7):889–897.

    Google Scholar 

  26. Ridgely S, Giard J, Shern D. Florida's Medicaid mental health carveout: lessons from the first years of implementation.Journal of Behavioral Health Services & Research. 1999;26(4):400–415.

    Google Scholar 

  27. Dillman D.Mail and Telephone Surveys: The Total Design Method. New York: John Wiley & Sons Inc; 1978.

    Google Scholar 

  28. Salant P, Dillman D.How to Conduct Your Own Survey, New York: John Wiley & Sons Inc; 1992.

    Google Scholar 

  29. Boothroyd R, Shern D.Assessing the Feasibility of Using Mail Survey Methodology With Medicaid Enrollees: A Summary of a Pilot Study for the member survey. Tampa, Fla: Louis de la Parte Florida Mental Health Institute, University of South Florida; 1998.

    Google Scholar 

  30. Jellinek M, Murphy J. Screening for psychosocial disorders in pediatric practice.American Journal of Diseases of Children. 1988;112:1153–1157.

    Google Scholar 

  31. Murphy J, Reede J, Jellinek M, et al. Screening for psychosocial dysfunction in inner-city children: further validation of the pediatric symptom checklist.Journal of the American Academy of Child and Adolescent Psychiatry. 1992;31(6):1105–1111.

    Google Scholar 

  32. Shern D, Giard J, Robinson P, et al.Evaluation of Florida's Prepaid Mental Health Plan: Year 4 Report. Tampa, Fla: University of South Florida, Louis de la Parte Florida Mental Health Institute; 2001.

    Google Scholar 

  33. Maynard C, Ehreth J, Cox G, et al. Racial differences in the utilization of public mental health services in Washington State.Administration and Policy in Mental Health. 1997;24(5):411–424.

    Google Scholar 

  34. Diala C, Muntaner C, Walrath C, et al. Racial differences in attitudes toward professional mental health care and in the use of services.American Journal of Orthopsychiatry. 2000;70(4):455–464.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Center for Mental Health Policy and Services Research, University of Pennsylvania, 3535 Market Street, 3rd Floor, 19104-3309, Philadelphia, PA

    David S. Mandell ScD (Assistant Professor)

  2. the Department of Mental Health Law & Policy in Louis de la Parte Florida Mental Health Institute at University of South Florida, Tampa, Florida

    Roger A. Boothroyd PhD (Associate Professor)

  3. Policy and Services Research Data Center in Department of Mental Health Law & Policy, Louis de la Parte Florida Mental Health Institute at University of South Florida, Tampa, Florida

    Paul G. Stiles JD, PhD (Assistant Professor and Co-Director)

Authors
  1. David S. Mandell ScD
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  2. Roger A. Boothroyd PhD
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  3. Paul G. Stiles JD, PhD
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Correspondence to David S. Mandell ScD.

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Mandell, D.S., Boothroyd, R.A. & Stiles, P.G. Children's use of mental health services in different Medicaid insurance plans. The Journal of Behavioral Health Services & Research 30, 228–237 (2003). https://doi.org/10.1007/BF02289810

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