Effects of Managed Mental Health Care on Service Use in Urban and Rural Maine |
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| Authors: | David Hartley PhD |
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| Institution: | Hartley is director of the Division of Rural Health and Associate Professor of Health Policy and Management in the Edmund s. Muskie School of Public Service at the University of Southern Maine in Portland Me. He is also chair of the master's program in Health Policy and Management at the university. Hartley has conducted research in the area of rural medical technology and the rural uninsured, and he is currently involved in several studies of rural mental health services and the rural informal safety net. |
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| Abstract: | This study takes advantage of a "natural experiment" resulting from the reassignment of all Maine state employees to a managed behavioral health plan in December 1992. By comparing mental health claims before and after that date, the effects of a behavioral health carve-out on mental health utilization by rural and urban beneficiaries were investigated. Following the implementation of the carve-out, the penetration rate, defined as the proportion of beneficiaries who sought help for an affective disorder, increased significantly in both rural and urban areas (P < 0.001). However, the rural penetration rate remained significantly lower than the urban rate (before implementation, 25.8 vs. 52.2 users per 1,000 enrollees, P < 0.001; after implementation, 57.8 vs. 85.8 users per 1,000 enrollees, P < 0.001). Similarly, rural utilization rates, defined as the average number of outpatient mental health visits per user, were significantly lower than urban rates both before and after implementation of the carve-out (before, 9.2 us. 12.9 visits per user, P < 0.001; after, 9.8 vs. 13.3 visits per user, P < 0.001). Before-after differences were not significant. In addition, the proportion of mental health care provided in the primary care setting increased after implementation of the carve-out (from 9.5 percent of all visits before to 12.6 percent of all visits after, P < 0.001). The increase in penetration rates can be attributed, in part, to a member education initiative undertaken during the transition from fee-for-service to managed care. This type of carve-out arrangement does not threaten to reduce access to mental health services, provided the managed behavioral health organization (MBHO) managing the carve-out is willing to accept primary care practitioners as part of its provider network. |
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