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

Abstract #71572

Marilyn Daley, PhD¹, Yvonne Anthony, PhD², and Donald S. Shepard, PhD¹. (1) Schneider Institute for Health Policy, Heller School for Social Policy and Management, Brandeis University, MS 035, 415 South Street, Waltham, MA 02454-9110, 781-736-3906, daley@brandeis.edu, (2) Schneider Institute for Health Policy, Heller Graduate School for Social Policy and Management, Brandeis University, MS 35,415 South St, Waltham, MA 02454-9110

Although public sector managed behavioral health care (MBHC) has successfully reduced Medicaid expenditures on substance abuse treatment, its impact on the quality of services received by racial minority clients has rarely, if ever, been examined. This study tracks Medicaid claims over a 5 (FY1992 to FY1996) year period to examine how the introduction of an MBHC carve-out in FY1993 affected three proxy measures of quality - access to substance abuse treatment, continuity of care and 30 day re-admission rates - for black, white and hispanic Medicaid enrollees in Massachusetts. Methods: Logistic and OLS regression to control for demographic characteristics and historical trends. Findings: Drug of choice, type of treatment utilized, eligibility group membership, age and gender differed radically by minority group membership. Access to substance abuse treatment increased more for hispanics (62%) than for whites (46%) or blacks (22%). In addition, logistic regression with year by race interaction effects showed that continuity of care improved 50% more for blacks, a significant difference. Although the likelihood of a rapid re-admission to acute treatment services increased by 25% overall, this outcome did not differ by racial status. Although the carve-out had a mixed impact on the quality of treatment for all Medicaid enrollees, findings suggest that managed care did not neglect services to minorities in an effort to contain costs, and may in fact have improved the quality of services for many minority clients. Possible explanations: Overall trend toward greater cultural competence in the provision of treatment services and contracting with established providers in minority communities.

Learning Objectives:

• Identify strategies used by managed care organizations to reduce spending and preserve the quality of substance abuse treatment programs
• Discuss the impact of these strategies on access, continuity and 30-day re-admissions for black, white and hispanic Medicaid enrollees
• Identify some of the historical barriers to drug and alcohol treatment that have existed for racial minority groups and ways that these can be minimized

Keywords: Substance Abuse Treatment, Minorities

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.