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Electronic Letters to:
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eLetters: Electronic letters published:
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Managed mental health care and its effect on the poor
- Leopoldo Cabassa (26 November 2001)
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Leopoldo Cabassa, Doctoral Student - NIMH Predoctoral Fellow Washington University, George Warren Brown School of Social Work
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ljc1{at}gwbmail.wustl.edu Leopoldo Cabassa
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The research article by Alegria et al. (2001) in the September issue addressed some of the key concerns regarding how the implementation of managed mental health care affects the accessibility of services among the poor. Although they used data from the Puerto Rico health reform and their findings can only be generalized to States that implement similar managed care reforms, the results of this study provide strong evidence that the safety net of health care services for the poor was not negatively impacted by the incorporation of a managed care system and the privatization of public facilities. In fact, they found that the expansion of the eligibility criteria for the Medicaid program to non-poor individuals (e.g. up to 200% above the federal poverty level) increased these individuals use of specialty mental health services without affecting the service level use of the poor. These findings suggest, at least in the context of Puerto Rico and other states that have undergone similar health reforms, that expanding eligibility translates into increasing accessibility for some individuals in need. The implications of these findings to policy makers and health service administrators is whether managed care and privatization will help reduce some of the mental health service use disparities seen among the poor and near poor racial and ethnic minority populations in the U.S. In other words, would expanding eligibility and increasing the choices for care to poor and near poor populations have a positive effect on the accessibility and service use among those with the most needs? If Alegria and colleagues findings can be replicated in other States, the knowledge accumulated by these studies will contribute to the understanding of factors that may help ameliorate service disparities among these groups. Alegria et al. (2001) and others (e.g. Crowford, Fisher, McDermiet, 1998) are uncovering the strong effects that enabling factors such as increased accessibility produced by managed care, systematic restructuring of public systems as well as administrative changes have on the utilization of mental health services among these populations. Future studies examining the convergence between quality of care and these types of health care reforms would provide a better understanding of the factors that impact the use of mental health services among the poor and near-poor populations. Increasing accessibility among these populations using managed care strategies should be carefully implemented without compromising quality of care. References Alegria, M., McGuire, T., Vera, M., Canino, G., Matias, L, & Calderon, J. (2001). Changes in access to mental health care among the poor and nonpoor : Results from the health care reform in Puerto Rico. American Journal of Public Health, 91 (9), 1431-1434. Carwford, K. Fisher, W., McDermeit, M. (1998). Racial/Ethnic disparities in admissions to public and private psychiatric inpatient settings: The effects of managed care. Administration and Policy in Mental Health, 26 (2), 101-109. |
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