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- Title
Specialty health care, treatment patterns, and quality: the impact of a mental health carve-out on care for depression.
- Authors
Busch, Susan H
- Abstract
<bold>Objectives: </bold>To assess the effect of a mental health carve-out on treatment patterns and quality of care for outpatient treatment of depression.<bold>Data Sources: </bold>Outpatient and pharmaceutical claims from September 1993 through March 1997 for one large managed care organization in the Midwest that carved-out mental health and substance abuse benefits in September 1995.<bold>Research Design: </bold>Using the treatment episode as the unit of analysis (n = 1,747), changes in treatment patterns associated with the change to a carve-out were evaluated. Logistic regression was used to assess whether in the postperiod a treatment episode was more likely to be treated with (1) an antidepressant and (2) a type and intensity of treatment with proven efficacy. To strengthen confidence in a causal relationship, I search for structural breaks in treatment patterns across a wide range of dates, assuming no a priori knowledge of the timing of the impact of the carve-out.<bold>Results: </bold>I find the carve-out to be associated with an increase in the use of drug treatments. Although I find a decrease in the use of guideline-level treatment over the entire study period, there is an increase in the number of episodes treated with guideline-level treatment over what would be the case in the absence of the carve-out.<bold>Conclusions: </bold>The increase in the use of drug treatments suggests previous research that excluded these costs may have overestimated the savings attributable to carve-outs. Guideline-level care appeared to increase as a result of carve-out implementation suggesting the use of management and specialization to reduce costs is not antithetical to quality improvement.
- Subjects
MIDWEST (U.S.); MENTAL depression; THERAPEUTICS
- Publication
Health Services Research, 2002, Vol 37, Issue 6, p1583
- ISSN
0017-9124
- Publication type
journal article
- DOI
10.1111/1475-6773.11092