The Colorado Symptom Index (CSI: Shern et al. 1994, Milbank Quart 72:123-148) is widely used in research as a self-report measure of psychiatric symptomatology, yet little information exists regarding the scale's psychometric properties. Additionally, the CSI has no cut-off score denoting the need for further psychiatric assessment. This study examined the CSI's psychometric properties and established a cut-off score. Analyses were based on 3,874 adult Florida Medicaid respondents. The CSI had excellent internal consistency (.92) and test-retest reliability (.71). Evidence of the CSI's validity was strong; CSI scores distinguished among individuals with and without mental health services needs and were significantly correlated with functioning. Results using a contrasting groups approach indicate that 30 is a reasonable "clinical" cut-off score. At this score, the CSI had respectable sensitivity (.76) and specificity (.68) and a ROC curve analysis suggests that the CSI is "fair to good" discriminator of individuals with psychiatric disabilities.
The stigma of mental illness is one of the factors that prevents Asian Americans/Pacific Islanders (APIs) from seeking formal mental health services. A somatic complaint is more acceptable in expressing psychiatric/emotional distress. Admission diagnoses in API emergency service users with secondary psychiatric diagnoses were identified from the 2001 National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP). The sample consisted of 10,623 adult APIs. The study examined the differences in the six leading principal physical admission diagnoses between API emergency service users with psychiatric diagnoses and those without psychiatric diagnoses. Several of the study findings create concern (e.g., the higher percentage of APIs with psychiatric diagnosis who were discharged against medical advice, the high percentage admitted with medication intoxication). Further study is needed to provide guidance for clinical practice.
Treatment costs for adults with severe mental illnesses can be contained by placing providers at financial risk. However, risk arrangements may also increase treatment costs borne by other payers including charity services and self-pay. Evaluating the impact of at-risk financing mechanisms from a public health perspective requires assessing cost shifting, particularly for pharmaceuticals.
Understanding the distribution of societal costs is essential in evaluating health care financing strategies. For adults with mental illnesses, efforts to manage Medicaid expenditures may result in substituting individual and family resources for Medicaid services. Government must focus on the distribution of societal costs since risk-based financing strategies may redistribute costs across the fragmented human services sector and result in unintended system inefficiencies.
This article summarizes the findings from a study examining the predictors of satisfaction among individuals enrolled in a county-sponsored indigent health care plan. Mail survey procedures were used to obtain information from enrollees regarding their satisfaction with the health care plan, as well as enrollees' demographics, health care status, and trust in their providers. Results of a stepwise regression model developed using a random half of the respondents revealed enrollees' trust in health care providers was the strongest predictor of general satisfaction, followed by perception of change in health status, and age. The model explained 49% of the variance and demonstrated little shrinkage when cross-validated on the remaining half of the respondents. Trust in health care providers, followed by perception of change in health status also emerged as the strongest predictors of enrollees' satisfaction with freedom of choice.
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