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Margarita Alegría, PhD, Thomas McGuire, PhD, Mildred Vera, PhD, Glorisa Canino, PhD, Leida Matías, PhD and José Calderón, MS

Margarita Alegría, Mildred Vera, Leida Matías, and José Calderón are with the Graduate School of Public Health, University of Puerto Rico, San Juan. Thomas McGuire is with the Department of Economics, Boston University, Boston, Mass. Glorisa Canino is with the School of Medicine, University of Puerto Rico.

Correspondence: Requests for reprints should be sent to Margarita Alegría, PhD, CIES, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067 (e-mail: malegria{at}rcm.upr.edu).

Objectives. Health care reforms associated with managed care may adversely affect the health care safety net for disadvantaged populations. This study compared changes in health care use among poor and nonpoor individuals enrolled in managed care.

Methods. Data from 3 waves of a random community sample were collected on approximately 3000 adults. Changes in use of mental health services were assessed in a pretest–posttest, quasi-experimental design.

Results. Managed care increased use of specialty services among the nonpoor while maintaining the same level of use for the poor in the public sector.

Conclusions. Reallocation of mental health services may be a result of expanding Medicaid eligibility.

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