Does managed care affect the diffusion of psychotropic medications?

Newer technologies to treat many mental illnesses have shown substantial heterogeneity in diffusion rates across states. In this paper, I investigate whether variation in the level of managed care penetration is associated with changes in state-level diffusion of three newer classes of psychotropic medications in fee-for-service Medicaid programs from 1991-2005. Three different types of managed care programs are examined: capitated managed care, any type of managed care and behavioral health carve-outs. A fourth order polynomial fixed effect regression model is used to model the diffusion path of newer antidepressant and antipsychotic medications controlling for time-varying state characteristics. Substantial differences are found in the diffusion paths by the degree of managed care use in each state Medicaid program. The largest effect is seen through spillover effects of capitated managed care programs; states with greater capitated managed care have greater initial shares of newer psychotropic medications. The influence of carve-outs and of all types of managed care combined on the diffusion path was modest

Expedited Medicaid, Mental Health Service Use, and Criminal Recidivism among Released Prisoners with Severe Mental Illness

To investigate whether Washington State’s 2006 policy of expediting Medicaid enrollment for offenders with severe mental illness released from state prisons increased Medicaid access and use of community mental health services while decreasing criminal recidivism

A Multilevel Logit Estimation of Factors Associated With Modern Contraception in Urban Nigeria

This study aimed to estimate the multilevel determinants of modern contraceptive use among reproductive-age women living in six cities in Nigeria (Abuja, Benin, Ibadan, Ilorin, Kaduna, and Zaria). Data from cross-sectional surveys conducted between 2010 and 2011 were linked to provide information on five hierarchical levels of the Socioecological Framework. Multilevel logit models estimated the odds of modern contraceptive use among 9,473 non-pregnant married/cohabiting women aged 15–49 years living in 488 clusters. About 25 percent of the women reported using modern contraceptive methods at the time of survey. Individual-level factors found to have a positive association with modern contraceptive use were parity, family planning self-efficacy, and partner discussion about fertility desires while perception of negative attitudes from community member about contraceptive use was negatively associated with modern contraceptive use (p < 0.05). At the community level, media exposure to family planning messages and city of residence were significantly associated with modern contraceptive use in the studied sample (p < 0.05). The positive association between parity and modern contraceptive use was modified by the community’s ideal family size. The results of this study support the evidence for multilevel interventions as a way to improve the prevalence of modern contraceptive use in urban Nigeria

Medicaid Outpatient Utilization for Waterborne Pathogenic Illness following Hurricane Floyd

OBJECTIVES: Flooding provides an opportunity for epidemics of waterborne viral, protozoan, or bacterial diseases to develop in affected areas. Epidemic levels of disease may translate into higher than average levels of health services use, depending in part on help-seeking behaviors. The authors investigated whether the flooding that occurred as a result of Hurricane Floyd in September 1999 was associated with an increase in outpatient visits for waterborne diseases among Medicaid enrollees in eastern North Carolina. METHODS: Using a difference-in-differences estimation technique, the authors examined the change in outpatient visits by North Carolina Medicaid enrollees for selected waterborne diseases following the hurricane. The study focused on counties with high concentrations of hog farming that were mildly/moderately or severely affected by the hurricane, using unaffected counties and the year before the hurricane as controls. RESULTS: Small increases in Medicaid-covered outpatient visits were found in severely affected counties for two of the six pathogens selected for analysis, relative to unaffected counties. Larger increases in visits were found for nonspecific intestinal infections in both severely and moderately affected counties following the hurricane, relative to unaffected counties. CONCLUSIONS: The large increase in visits for ill-defined intestinal infection is noteworthy. The relative lack of increase in visits with specific pathogenic diagnoses may be attributable, at least in part, to a number of factors, including incomplete diagnostic information provided by treating clinicians, low treatment-seeking behavior, and use of non-Medicaid-funded emergency services

Within Group "Structural" Tests of Labor-Market Discrimination: A Study of Persons with Serious Disabilities

Labor-market discrimination measures are usually derived from between-group comparisons of market outcomes for favored vs. disfavored groups, controlling for productivity-related individual characteristics. When the disfavored group is heterogeneous, one can relate variations in discrimination intensity to market outcomes within the disfavored group. We use this approach to test for employment and wage discrimination against persons with various types of disabilities. Measures of social distance' controls for the intensity of discrimination. In a national sample of adults with serious disabilities, employment discrimination effects are in the wrong' direction, however, and wage effects are unstable. Thus, variability in labor market outcomes among different types of disabilities is not explained well by variations in discrimination intensity correlated with social distance and employer attitudes. We conjecture that differences in available support services by type of disability may help to explain this variability.

Connecting Mentally Ill Detainees in Large Urban Jails with Community Care

Large urban jails have become a collection point for many persons with severe mental illness. Connections between jail and community mental health services are needed to assure in-jail care and to promote successful community living following release. This paper addresses this issue for 2855 individuals with severe mental illness who received community mental health services prior to jail detention in King County (Seattle), Washington over a 5-year time period using a unique linked administrative data source. Logistic regression was used to determine the probability that a detainee with severe mental illness received mental health services while in jail as a function of demographic and clinical characteristics. Overall, 70 % of persons with severe mental illness did receive in-jail mental health treatment. Small, but statistically significant sex and race differences were observed in who received treatment in the jail psychiatric unit or from the jail infirmary. Findings confirm the jail's central role in mental health treatment and emphasize the need for greater information sharing and collaboration with community mental health agencies to minimize jail use and to facilitate successful community reentry for detainees with severe mental illness

Service Utilization Patterns as Predictors of Response to Trauma-Informed Integrated Treatment for Women With Co-occurring Disorders

The current study examined whether clinical responses to an integrated treatment intervention among women with co-occurring disorders and histories of abuse varied according to their service use patterns at baseline

Continuity of medication management in Medicaid patients with chronic comorbid conditions: An examination by mental health status

Patients with serious mental illness (SMI) often have comorbid cardiometabolic conditions (CMCs) that may increase the number of prescribers involved in treatment. This study examined whether patients with SMI (depression and schizophrenia) and comorbid CMCs experience greater discontinuity of prescribing than patients with CMCs alone

The Influence of Land Use on Aquatic Macroinvertebrates in Streams and Rivers of South Carolina

2008 S.C. Water Resources Conference - Addressing Water Challenges Facing the State and Regio