The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #66195

Joanna Volpe-Vartanian, MS, LICSW, Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, MS 35,415 South St, Waltham, MA 02454, (617) 734-5108, jvolpevartanian@aol.com, Dominic Hodgkin, PhD, Schneider Institute for Health Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, MS 035, Waltham, MA 02454, and Margarita Alegria, PhD, Center for Multicultural Mental Health Research, Cambridge Health Alliance, 120 Beacon street, 4th Floor, Somerville, MA 02143.

Mental health services are increasingly carved out of medical plans and delivered by managed behavioral healthcare organizations under a separate contract. Prior studies reported that carve-outs reduce treatment duration, although some reported that increased numbers of people enter treatment after a carve-out. Concern exists that carve-outs lead to undertreatment, and hamper coordination of psychiatric and other medical care. In addition, carve-outs may have differential effects on women's mental healthcare. There are well-documented epidemiologic disparities between genders, with unipolar depression and anxiety disorders twice as prevalent in women. Women's care is more fragmented during their childbearing years when vulnerability to mood disorders is highest. Given women's differential behavioral health characteristics and needs, there may be gender differences in how carve-outs affect: 1) access to specialty care, and 2) treatment intensity. In addressing these questions, this study benefits from interview data collected in three waves on a random community sample of adults living in low-income areas of Puerto Rico, where a carve-out was implemented across regions in stages. Respondents' mental health was assessed using standardized diagnostic instruments. They were asked about recent outpatient services utilization as well as their self-perception of mental health. Data collection began in 1992, before the introduction of managed care, and continued until 1998, when approximately two-thirds of the island's population were enrolled in carve-out plans. Preliminary results indicate that there appears to be a gender difference in the intensity of service use after the carve-out, with women's use per user declining more than men's.

Learning Objectives:

• List those mental health disorders more common in women than in men.
• Identify where men and women have been more likely to seek care for their mental health problems.
• Articulate how care delivery under a carve-out may differentially impact men's and women's access to any appropriate care as well as the intensity of that care.
• Apply findings from a study using data from the Puerto Rico to other comparable settings.

Keywords: Managed Care, Gender

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.