Article

Service use and health status of persons with severe mental illness in full-risk and no-risk Medicaid programs

Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 27599-7590, USA.
Psychiatric Services (Impact Factor: 1.99). 04/2002; 53(3):293-8. DOI: 10.1176/appi.ps.53.3.293
Source: PubMed

ABSTRACT The service use patterns and health status outcomes of Medicaid recipients with severe mental illness in a system that assigned full financial risk to managed care organizations through capitation and a system that paid for mental health care on a no-risk fee-for-service basis were compared.
With use of a quasi-experimental design, initial interviews (time 1) and follow-up interviews six months later (time 2) were conducted among 92 clients in the full-risk group and 112 clients in the no-risk group. Regression models were used to compare self-reported service use and health status between the two groups.
Service use patterns differed between the two groups. When symptom severity at time 1 was controlled for, clients in the full-risk group were more likely to have received case management but less likely to report contact with a psychiatrist or to have received counseling than clients in the no-risk group. When health status at time 1 was controlled for, clients in the full-risk group reported poorer mental health at time 2 than clients in the no-risk group. When physical health status at time 1 was controlled for, clients in the full-risk group reported poorer physical health at time 2 than clients in the no-risk group.
Capitation was associated with lower use of costly services. Clients with serious mental illness in the full-risk managed care system had poorer mental and physical health outcomes than those in the no-risk system.

Download full-text

Full-text

Available from: Elizabeth I. Merwin, Sep 23, 2014
0 Followers
 · 
76 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The CINAHL and MEDLINE databases were used to conduct a review of international rural nursing research published between 2003 and 2007. In total, 41 articles were reviewed and organized based on the United Nations Human Development Index, which categorizes countries based on development status. Critical review of international rural nursing research yielded three major organizational themes: clinical issues, aspects of nursing practice, and nursing and health policy research. Despite the variety in international locale of the research, these themes and other common findings emerged. The need for increased access to specialized nursing knowledge, resources, and support is an ongoing issue facing nurses in rural and remote settings.
    Annual review of nursing research 02/2008; 26:261-94.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Adverse events occur in virtually all health care arenas, and while rural health care settings are no exception, these facilities often face unique financial burdens and personnel shortages. That may hamper patient safety efforts. Many of the interventions recommended to improve patient safety have largely been based on research conducted in urban hospitals. This chapter demonstrates the extent and type of nursing research being conducted to advance rural-specific patient safety research. The studies were conducted in various settings, with topics ranging from error reporting in hospitals to safety screening in the community. Limitations of these works are discussed, and the chapter offers guidance for a future nursing research agenda to include the need for interdisciplinary research; cross-national and international collaboration; and, at a minimum, the necessity for nurse researchers to sample rural hospitals in larger studies of patient safety.
    Annual review of nursing research 02/2008; 26:195-218.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In 2006, the Institute of Medicine (IOM) released a series of reports that highlighted the urgent need for improvements in the nation's emergency health services. This news has provided new energy to a growing body of research about the development and implementation of best practices in emergency care. Despite evidence of geographical disparities in health services, relatively little attention has been focused on rural emergency services to identify environmental differences. The purpose of this chapter is to summarize the contributions of nursing research to the rural emergency services literature. The research resembles a so-called shotgun effect as the exploratory and interventional studies cover a wide range of topics without consistency or justification. Emergency nursing research has been conducted primarily in urban settings, with small samples and insufficient methodological rigor. This chapter will discuss the limitations of the research and set forth an agenda of critical topics that need to be explored related to emergency nursing in rural settings.
    Annual review of nursing research 02/2008; 26:117-41.

Similar Publications