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Public sector managed care: a comparative evaluation of substance abuse treatment in three counties
Author(s) -
Beattie Martha,
McDaniel Patricia,
Bond Jason
Publication year - 2006
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/j.1360-0443.2006.01432.x
Subject(s) - substance abuse , medicine , addiction , psychiatry , managed care , public sector , family medicine , psychology , health care , political science , law
Aims A study of publicly funded substance abuse treatment systems compared MidState, a county that reorganized its treatment system using managed care principles, to two other California counties that took different approaches, NorthState and SouthState. It was hypothesized that MidState would have better outcomes due to its emphasis on quality of care. Design This natural experiment compared the ‘experimental’ county, MidState, to two ‘control’ counties, assessing client outcomes following treatment. Administrative and historical exigencies that may affect system differences were explored in interviews with treatment program managers and staff. Settings Comparison counties were selected using treatment system and county census data, maximizing similarities to enhance internal validity. Participants Adult clients ( n = 681) were interviewed when beginning treatment and 12 months later (81% response rate). In addition, 50 treatment program managers and staff members across the three counties were interviewed during the year of client recruitment. Measurements Client interviews assessed functioning in the seven Addiction Severity Index domains—alcohol, drug, psychiatric, legal, employment, medical and family/social. Findings Outcomes (differences between baseline and 12 month composite scores) did not differ between counties in six of seven domains; in the seventh, psychiatric functioning, SouthState had better outcomes than MidState. Staff interviews indicated generally similar treatment strategies across counties, with MidState supplying greater oversight and performance standards. Conclusions Managed care in public sector treatment generally did not result in poorer outcomes. Future attention in MidState to the barriers to successful implementation of individualized treatment, and to dual diagnosis treatment, might bring more positive results.