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October 1996

Managing the Care of Schizophrenia: Lessons From a 4-Year Massachusetts Medicaid Study

Author Affiliations

From the Departments of Psychiatry (Dr Dickey) and Health Care Policy (Dr Normand), Harvard Medical School, Boston, Mass; Mental Health Services Research, McLean Hospital, Belmont, Mass (Dr Dickey and Mr Azeni); Department of Biostatistics, Harvard School of Public Health, Boston (Dr Normand); Center for Economics Research, Research Triangle Institute, Research Triangle Park, NC (Dr Norton); Center for Psychosocial and Forensic Services Research, University of Massachusetts Medical School, Worcester (Dr Fisher); and Mentor Inc, Boston (Dr Altaffer).

Arch Gen Psychiatry. 1996;53(10):945-952. doi:10.1001/archpsyc.1996.01830100095012

Background:  In 1992, Massachusetts launched a statewide managed care plan for all Medicaid beneficiaries.

Methods:  This retrospective, multiyear, crosssectional study used administrative data from the Massachusetts Division of Medical Assistance and Department of Mental Health, consisting of claims for 16 400 disabled adult patients insured by Medicaid in Massachusetts between July 1, 1990, and June 30, 1994. The main outcome measures include annual rates of hospitalization, emergency department utilization, and follow-up care 30 days after discharge; length of inpatient stay; and per-person inpatient and outpatient expenditures.

Results:  Between 1991 and 1994, the likelihood of an inpatient admission decreased from 29% to 24% and was accompanied by a slight reduction in length of stay (median number of bed-days per admission dropped by 3.3 days). There was a slight decrease in the number of patients who sought care in general hospital emergency department utilization. However, there was a small increase in the fraction of patients readmitted within 30 days of discharge. Medicaid and Department of Mental Health expenditures for mental health per treated beneficiary decreased slightly, from $11 060 to $10 640, during the 4-year study period.

Conclusion:  Although per-person expenditures dropped and most patient patterns of care remained the same, longer-term study is recommended to assess whether the trends can be maintained.

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