This study evaluates changes in patterns of acute psychiatric hospitalization under Massachusetts' Medicaid-funded Mental Health and Substance Abuse (MMHSA) carve-out program. The data consists of the Case Mix Database, for FY 1996 and FY 1997, compiled by the state's Division of Health Care Finance and Policy, on all acute hospital episodes in the state. Key comparisons involve hospital utilization during the nine months preceding the 1996 implementation of the current expanded carve-out program and the subsequent 15 months of its implementation. Secondary comparisons are made between patients funded by the state's two major Medicaid programs, its behavioral carve-out and its contracted HMOs, as well as with other cohorts. Key variables include demographic and diagnostic measures, length of stay and recidivism, source of referral, insurance, socioeconomic characteristicso f zip code of residence,a nd transfers between programs.

Findings include lower than anticipated rates of transfer from the free-care program to the behavioral carve-out program and higher than average and increasing levels of recidivism for patients in the behavioral carve-out program. The final model, based on a Cox regression analysis, correctly predicts 62.9% of the rehospitalization experience, a statistically significant portion of which was attributable to type of insurance coverage. The study also shows that neither the carve-out nor the HMO model of managed care are clearly superior one another.

Off-campus users:

You may need to log in to your campus proxy before being granted access to the full-text above.