Journal of urban health : bulletin of the New York Academy of Medicine
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Comparative Study
The evolving role and care management approaches of safety-net Medicaid managed care plans.
This article provides new empirical data about the viability and the care management activities of Medicaid managed-care plans sponsored by provider organizations that serve Medicaid and other low-income populations. Using survey and case study methods, we studied these "safety-net" health plans in 1998 and 2000. ⋯ Our study suggests that, with supportive state policies, safety-net plans are capable of remaining viable. Contracting with safety-net plans may not be an efficient mechanism for enabling Medicaid recipients to "enter the mainstream of American health care," but it may provide states with an effective way to manage and coordinate the care of Medicaid recipients, while helping to maintain the health care safety-net for the uninsured.
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We determined if illicit drug use frequency changes after a disaster by comparing drug use frequency in two street-recruited samples of heroin and cocaine users, ages 15-40 years. The users were interviewed between July 11 and November 11 and divided into before- and after-September 11th groups for analysis. The before and after groups were similar in the mean number of days of drug use per month (sniff cocaine 6.8 days vs. 9.4 days, respectively, P =.17; snorted heroin 13.9 vs. 14.0, respectively, P =.96; smoked crack 16.9 vs. 15.6, respectively, P =.96; and smoked marijuana 17.5 vs. 15.3, respectively, P =.36) and in the proportion of daily users: sniffed cocaine 10% versus 17%, respectively (P =.28); snorted heroin 47% versus 40%, respectively (P =.91); smoked crack 33% versus 37%, respectively (P =.68); and smoked marijuana 47% versus 40%, respectively (P =.41). Among street-recruited heroin and cocaine users in Harlem and the Bronx, the frequency of drug use did not increase following the events of September 11, 2001.
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There is evidence of increased rates of psychiatric disorder in New York City in the period following September 11th. Public mental health services need to develop plans to respond to these higher rates of disorder. This article describes what we know and do not know with respect to the costs of such response. We examine evidence on the demand for mental health services, the nature of services to be provided, the characteristics of providers, and the likely sources of payment for care in the context of the attacks of September 11th in New York City.
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The September 11th terrorist attacks had a dramatic impact on the mental health of millions of Americans. The impact was particularly severe in New York City and surrounding areas within commuting distance of the World Trade Center. ⋯ Individuals served vary widely in the severity of experienced trauma and associated traumatic reactions. Data from logs kept by Project Liberty workers suggest that individuals with the most severe reactions are being referred to longer-term mental health treatment services.