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Users of mental health and substance abuse (MH/SA) services were examined among nonelderly high-cost Medicaid enrollees in 10 states in 1995. Although MH/SA service users constitute 11% of all Medicaid enrollees, they make up nearly a third of high-cost enrollees. Adults account for two thirds of this high-cost MH/SA group, and most frequently qualify for Medicaid through disability-related eligibility...
The goal of this study was to identify variables associated with length of stay (LOS) and to incorporate into the authors' routine preadmission assessment the measurement of these variables. A retrospective study of 80 discharged patients explored the association of 25 variables reflecting a mixture of patient/demographic variables, illness variables, and treatment variables with LOS. Multivariate...
The authors analyzed changes in access to and use of mental health services by minorities in the Veterans Health Administration during a period of major system change (1995–2001). Blacks had poorer outpatient access than Whites during this period of change, but were not further disadvantaged over time, and their access to care improved relative to Whites on some measures. For Hispanics, there was...
Continuity of pharmacotherapy was examined between a state psychiatric hospital and an urban community mental health center. Anecdotal reports from administrators as well as limited empirical research suggested that there would be breaks in the continuity of pharmacotherapy across the two agencies and that the high cost of newer medications would contribute to poor continuity. Clinical chart reviews...
This paper presents national estimates of behavioral disorders among Medicaid recipients. The 12-month prevalence of 14 disorders in the National Comorbidity Survey was 48% (43% mental, 14% substance use), and of 6 disorders in the National Household Survey on Drug Abuse was 27% (21% mental, 9% substance use). Total and specific disorder rates are from 50% to more than 100% higher in Medicaid than...
Current changes require that behavioral health care leaders understand how public and private financing mechanisms interact and how, now more than ever, behavioral health care leadership must span multiple systems and financing streams. Understanding how financing mechanisms work, what they create, and what they cause is essential if we are to make the most of increasingly limited and increasingly...
One rationale for establishing programs that help patients manage their funds is that such patients make extensive use of expensive inpatient services. We surveyed the money management habits of 406 inpatients and determined their use of Veterans Administration (VA) services and related costs over the subsequent year. In multivariate analyses, there was no statistically significant relationship between...
A project is described in which performance measures of cultural competency in behavioral health care were selected and benchmarked. Input from an Expert Panel representing the four major ethnic and racial groups in the U.S. and persons with extensive experience in implementing cultural competency in health care, along with survey data from 21 sites were used in the process. Measures and benchmarks...
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