The journal of mental health policy and economics
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J Ment Health Policy Econ · Jun 2003
Closing service system gaps for homeless clients with a dual diagnosis: integrated teams and interagency cooperation.
There is great concern about fragmentation of mental health service delivery, especially for dually diagnosed homeless people, and apprehension that such fragmentation adversely affects service access and outcomes. ⋯ Research on approaches to reducing system fragmentation have focused on either global efforts to integrate numerous agencies in a community or highly focused efforts to develop specialized teams. Future research should also focus on the possibility of fostering constructive relationships between selected pairs or subsets of agencies. Research in this area will also benefit from the further development measures of team integration and of both intra-team and inter-agency communication, collaboration, and trust.
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J Ment Health Policy Econ · Mar 2003
ReviewEfficacy and cost-effectiveness of the first generation of HIV prevention interventions for people with severe and persistent mental illness.
People with serious mental illness are at elevated risk for human immunodeficiency virus (HIV) infection. A small body of published research has evaluated the efficacy of HIV prevention interventions that aim to help persons with mental illness modify sexual behaviors that place them at risk for HIV infection. Additional research has evaluated the economic efficiency ('cost-effectiveness') of these interventions. ⋯ To advance the field, the next generation of intervention research for people with severe mental illness will need to improve upon the designs and intervention strategies of the first generation, include larger samples, and devote increased attention to the life circumstances and particular mental health issues of intervention participants.
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J Ment Health Policy Econ · Mar 2003
Managed care, networks and trends in hospital care for mental health and substance abuse treatment in Massachusetts: 1994-1999.
Rates of inpatient care for mental health and substance abuse treatment have been reported to fall after the introduction of managed care, but the actual decline may be overstated. Almost all managed care impact studies are based on pre-post comparisons, which have two drawbacks: secular downward trends may be attributed to a managed care effect and self-selection may exaggerate the impact of managed care. Therefore it is useful to examine long-term population-based trends in use associated with the growth of managed care. ⋯ This paper provides the groundwork for extending the analysis to areas with market characteristics different to those of Massachusetts. Further research should focus on the long-term trends in health outcomes between managed care and fee for service patients.
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J Ment Health Policy Econ · Dec 2002
Consistency in performance evaluation reports and medical records.
In the health care market managed care has become the latest innovation for the delivery of services. For efficient implementation, the managed care organization relies on accurate information. So clinicians are often asked to report on patients before referrals are approved, treatments authorized, or insurance claims processed. What are clinicians responses to solicitation for information by managed care organizations? The existing health literature has already pointed out the importance of provider gaming, sincere reporting, nudging, and dodging the rules. ⋯ Our work in this paper on the data sets confirms the statistical significance of strategic reporting in alcohol addiction treatment. It will be of interest to confirm our finding in other data sets. Our on-going research will model the motives behind strategic reporting. We will hypothesize that both altruistic and financial incentives are present. Our empirical identification strategy will use Maine s Performance-Based Contracting system and client insurance sources to test how these incentives affect the direction of clinician s strategic reporting.
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In the US, the spiraling costs of substance abuse and mental health treatment caused many state Medicaid agencies to adopt managed behavioral health care (MBHC) plans during the 1990s. Although research suggests that these plans have successfully reduced public sector spending, their impact on the quality of substance abuse treatment has not been established. ⋯ The impact of managed behavioral health care should ideally be evaluated in randomized controlled studies. In addition, research is needed to establish that the quality measures employed in this evaluation - improved access, enhanced continuity and fewer rapid re-admissions actually correspond to reductions in drug or alcohol use and other favorable outcomes obtained through client self-report or urinalysis.