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: 2.41). 04/2002; 53(3):293-8. DOI: 10.1176/
Source: PubMed


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.

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    • "During the study period, 10% and later 15% of FFS claims were paid to these PCPs. US studies that compared care delivered to persons with SMI in different primary care models have shown that capitation is associated with increased or decreased use of outpatient care (Busch et al. 2004; Chou et al. 2005; Leff et al. 2005; Morrissey et al. 2002) and fewer mental health hospital admissions (Bloom et al. 2002; Leff et al. 2005; Rothbard et al. 2004; Warner and Huxley 1998). Many of those studies, however, are dated, and many were based on unrepresentative samples. "
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