The Impact of Managed Care on the Use of Outpatient Mental Health and Substance Abuse Services in Puerto Rico

Alegrı́a, Margarita; McGuire, Thomas G.; Vera, Mildred; Canino, Glorisa; Freeman, Daniel; Matías, Leida; Albizu, Carmen; Marín, Heriberto; Calderón, José Luis Pontijas

doi:10.5034/inquiryjrnl_38.4.381

Cited by 21 publications

(12 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lay interviewers collected the data through face to face interviews. In-depth details of the study design and subject selection criteria have been published previously [29, 30]. …”

Section: Methodsmentioning

confidence: 99%

Correlates Associated with Unipolar Depressive Disorders in a Latino Population

et al. 2012

Self Cite

View full text Add to dashboard Cite

Background: This study reports the comparison and associations of demographic, clinical and psychosocial correlates with three unipolar depressive disorders: dysthymia (DYS), major depression (MD) and double depression (DD), and examines to which extent these variables predict the disorders. Sampling and Method: Previously collected data from 563 adults from a community in Puerto Rico were analyzed. One hundred and thirty individuals with DYS, 260 with MD and 173 with DD were compared by demographic variables, psychiatric and physical comorbidity, familial psychopathology, psychosocial stressors, functional impairment, self-reliance, problem recognition and formal use of mental health services. Multinomial regression was used to assess the association of the predictor variables with each of the three disorders. Results: Similarities outweighed the discrepancies between the disorders. The main differences observed were between MD and DD, while DYS shared common characteristics with both MD and DD. After other variables were controlled, anxiety, functional impairment and problem recognition most strongly predicted a DD diagnosis, while age predicted a DYS diagnosis. Conclusion: MD, DYS and DD are not completely different disorders, but they do differ in key aspects that might be relevant for nosology, research and practice. A dimensional system that incorporates specific categories of disorders would better reflect the different manifestations of unipolar depressive disorders.

show abstract

“…Lay interviewers collected the data through face to face interviews. In-depth details of the study design and subject selection criteria have been published previously [29, 30]. …”

Section: Methodsmentioning

confidence: 99%

Correlates Associated with Unipolar Depressive Disorders in a Latino Population

et al. 2012

Self Cite

View full text Add to dashboard Cite

show abstract

“…In practice, hospital services sometimes change little, and care providers such as doctors and nurses continue to work in much the same way as before. For example, McGuire et al [2] studied the effects of privatization of outpatient mental health and substance abuse services in Puerto Rico, finding that privatization had minimal impact on use. Clark et al [6] reviewed evidence on differences in the performance of care provider agencies that ranged from fully government-owned to fully private, and noted no obvious differences in performance in terms of ownership.…”

Section: Advantages and Disadvantages Of Corporatizationmentioning

confidence: 98%

Can Questions of the Privatization and Corporatization, and the Autonomy and Accountability of Public Hospitals, Ever be Resolved?

2010

View full text Add to dashboard Cite

Although there is a long-standing international debate concerning the privatization and corporatization of health services, there has been relatively little systematic analysis of the ways these types of reform manifest. We examine the impact of privatization and corporatization on public hospitals, and in particular on hospitals' autonomy and accountability, with two aims: to uncover the key themes in the literature, and to consider implementation issues. The review of 2,319 articles was conducted using content analysis and a discussion of selected key issues. Several major themes appear in the privatization and corporatization literature, including their use as tools in health systems reform, and the role of governments in sponsoring the processes. We show that much of the underlying argument is ideological rather than evidence based. Those who promote versions of privatization or corporatization claim that decreased government involvement in the management of hospitals leads inter alia to benefits such as greater efficiency, better quality services, and increased choice for patients. Those who argue against say that increased privatization leads to deleterious outcomes such as decreased equity, compromised efficiency and poorer quality of care. The evidence is often weak and at times conflicting. Privatization and corporatization are difficult to implement, and at best produce mixed results, and their impact seems to depend more on the motivation of the evaluator than the standard of the results. These debates are of a type that is to a large extent only resolvable ideologically.

show abstract

“…Medicaid managed care programs in 47 states have mental health components (McFarland, 2000;Rothbard et al, 2002). Studies in Arizona (Leff, Mulkern, Lieberman, & Raab, 1994), Colorado (Bloom et al, 2002;Warner & Huxley, 1998), Massachusetts (Dickey et al, 2003), Nebraska (Bouchery & Harwood, 2003), Pennsylvania (Rothbard, Kuno, Hadley, & Dogin 2004), and Puerto Rico (Alegrie, McGuire, & Vera, 2001a;Alegrie et al 2001b) suggested there was little impact from converting fee for service Medicaid mental health to managed care. However, work in Florida (Boothroyd, Shern, & Bell, 2002), Minnesota (Lurie, Moscovice, Finch, Christianson, & Popkin, 1992), Tennessee (Chang et al, 1998;Ray, Daugherty, & Meador, 2003), Utah (Manning, Liu, & Stoner, 1999), and Virginia (Morrissey, Stroup, Ellis, & Merwin, 2002) raised concerns about the impact of Medicaid managed care on clients with serious mental disorders such as schizophrenia.…”

Section: Introductionmentioning

confidence: 95%

Outcomes for Rural Medicaid Clients with Severe Mental Illness in Fee for Service versus Managed Care

Bianconi

Mahler

McFarland

2006

Adm Policy Ment Health

View full text Add to dashboard Cite

This study compared outcomes for rural Medicaid clients with severe mental illness in fee for service versus managed care programs. Interviews were conducted with 305 Medicaid clients in rural Oregon (166 in fee for service and 139 in managed care). Logistic and multivariate regression analyses were used to examine client satisfaction, safety, symptoms, functioning, and family satisfaction in the fee for service versus managed care groups. There was no evidence that conversion of the Medicaid mental health system from fee for service to managed care led to changes in outcomes for rural clients with severe mental illness.

show abstract

The Impact of Managed Care on the Use of Outpatient Mental Health and Substance Abuse Services in Puerto Rico

Cited by 21 publications

References 10 publications

Correlates Associated with Unipolar Depressive Disorders in a Latino Population

Correlates Associated with Unipolar Depressive Disorders in a Latino Population

Can Questions of the Privatization and Corporatization, and the Autonomy and Accountability of Public Hospitals, Ever be Resolved?

Outcomes for Rural Medicaid Clients with Severe Mental Illness in Fee for Service versus Managed Care

Contact Info

Product

Resources

About