How capitated mental health care affects utilization by youth in the juvenile justice and child welfare systems.

Examine the impact of Colorado's Medicaid mental health carve-out program on children in child welfare and juvenile justice systems. Medicaid claims and encounter data for two experimental managed care sites and one comparison fee-for-service site are used to estimate a two-part model of inpatient, outpatient, and residential treatment center utilization, controlling for patient characteristics. The study finds that juvenile justice and child welfare populations were more strongly affected by managed care than the general youth population, regarding reduced utilization of inpatient and outpatient services. Increases in Residential Treatment Centers use were greater for juvenile justice than either the child welfare sample or the total sample. Youth in child welfare increase utilization of outpatient services. Most utilization effects are stronger for not-for-profit than for-profit managed care organizations. The experience of Colorado implies that a mental health carve-out affects patterns of care for youth and differentially so for youth in juvenile justice and child welfare systems. Controlling for population characteristics, the effects are stronger for not-for-profit than for-profit managed care organizations.

The effect of capitated financing on mental health services for children and youth: the Colorado experience.

OBJECTIVES: This study tested 2 propositions concerning the effect of capitated financing on mental health services for Medicaid-eligible children and youth in Colorado. The first is that capitation reduces costs. The second is that shifting providers from fee-for-service to capitated financing will increase their efforts to prevent illness. METHODS: Interrupted time-series designs were applied to a naturally occurring quasi experiment occasioned by the state of Colorado's reorganization of mental health services financing. RESULTS: The cost of services was significantly lower in counties with capitated services compared with counties with fee-for-service financing. Findings also suggested that economic incentives may lead to greater efforts at secondary and tertiary prevention. CONCLUSIONS: Policymakers and the public can expect that capitation will reduce the costs of children's mental health services below those likely with fee-for-service financing. Capitation per se, however, may not increase prevention as surely or swiftly as it lowers costs.

Can social insurance for long-term care work? The experience of Germany.

In 1994 Germany enacted a universal-coverage social insurance program for long-term care to largely replace its means-tested system. The program has achieved many of its stated policy goals: shifting the financial burden of long-term care off the states and municipalities; expanding home and community-based services; lessening dependence on means-tested welfare; and increasing support of informal caregivers. Many of these goals were reached without exploding caseloads or uncontrolled expenditures. We examine the German long-term insurance program, focusing on issues of financing, eligibility and assessment, benefits, availability of services, and quality assurance.

Public and private responsibilities: home- and community-based services in the United Kingdom and Germany.

In the late 1980s, the United States, the United Kingdom, and Germany had roughly the same system of financing and delivering long-term care. In contrast to the United States, the United Kingdom and Germany enacted radical reform. The United Kingdom converted an open-ended, means-tested national entitlement for institutional care to a block grant to local governments, whereas Germany enacted a nationally uniform, non-means-tested social insurance program. This article analyzes the postreform experience of the United Kingdom and Germany with respect to issues of financing, assessment and case management, and the availability of home- and community-based services. Policy implications for the United States are developed.