Does Type of Gatekeeping Model Affect Access to Outpatient Specialty Mental Health Services?

OBJECTIVE: To measure how a change in gatekeeping model affects utilization of specialty mental health services. DATA SOURCES/STUDY SETTING: Secondary data from health insurance claims for services during 1996–1999. The setting is a managed care organization that changed gatekeeping model in one of...

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Main Authors: Hodgkin, Dominic, Merrick, Elizabeth L, Horgan, Constance M, Garnick, Deborah W, McLaughlin, Thomas J
Formato: Artigo
Idioma:English
Publicado em: Blackwell Science Inc 2007
Assuntos:
Access and Disparities
Acesso em linha:https://ncbi.nlm.nih.gov/pmc/articles/PMC1955246/
https://ncbi.nlm.nih.gov/pubmed/17355584
https://ncbi.nlm.nih.govhttp://dx.doi.org/10.1111/j.1475-6773.2006.00609.x
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spelling pubmed-19552462009-02-01 Does Type of Gatekeeping Model Affect Access to Outpatient Specialty Mental Health Services? Hodgkin, Dominic Merrick, Elizabeth L Horgan, Constance M Garnick, Deborah W McLaughlin, Thomas J Health Serv Res Access and Disparities OBJECTIVE: To measure how a change in gatekeeping model affects utilization of specialty mental health services. DATA SOURCES/STUDY SETTING: Secondary data from health insurance claims for services during 1996–1999. The setting is a managed care organization that changed gatekeeping model in one of its divisions, from in-person evaluation to the use of a call-center. STUDY DESIGN: We evaluate the impact of the change in gatekeeping model by comparing utilization during the 2 years before and 2 years after the change, both in the affected division and in another division where gatekeeping model did not change. The design is thus a controlled quasi-experimental one. Subjects were not randomized. Key dependent variables are whether each individual had any specialty mental health visits in a year; the number of visits; and the proportion of users exceeding eight visits in a year. Key explanatory variables include demographic variables and indicators for patient diagnoses and their intervention status (time-period, study group). DATA COLLECTION/EXTRACTION METHODS: Claims data were aggregated to create analytic files with one record per member per year, with variables reporting demographic characteristics and mental health service use. PRINCIPAL FINDINGS: After controlling for secular trends at the other division, the division which changed gatekeeping model eventually experienced an increase in the proportion of enrollees receiving specialty mental health treatment, of 0.5 percentage point. Similarly, there was an increase of about 0.6 annual visits per user, concentrated at the low end of the distribution. These changes occurred only in the second year after the gatekeeping changes. CONCLUSIONS: The results of this study suggest that the gatekeeping changes did lead to increases in utilization of mental health care, as hypothesized. At the same time, the magnitude of the increase in access and mean number of visits that we found was relatively modest. This suggests that while the change from face-to-face specialty gatekeeping to call-center intake does increase utilization, it is unlikely to overwhelm a system with new demand or create huge cost increases. Blackwell Science Inc 2007-02 /pmc/articles/PMC1955246/ /pubmed/17355584 http://dx.doi.org/10.1111/j.1475-6773.2006.00609.x Text en © Health Research and Educational Trust
institution US National Library of Medicine
collection PubMed Central
language English
format Article
topic Access and Disparities
spellingShingle Access and Disparities
Hodgkin, Dominic
Merrick, Elizabeth L
Horgan, Constance M
Garnick, Deborah W
McLaughlin, Thomas J
Does Type of Gatekeeping Model Affect Access to Outpatient Specialty Mental Health Services?
description OBJECTIVE: To measure how a change in gatekeeping model affects utilization of specialty mental health services. DATA SOURCES/STUDY SETTING: Secondary data from health insurance claims for services during 1996–1999. The setting is a managed care organization that changed gatekeeping model in one of its divisions, from in-person evaluation to the use of a call-center. STUDY DESIGN: We evaluate the impact of the change in gatekeeping model by comparing utilization during the 2 years before and 2 years after the change, both in the affected division and in another division where gatekeeping model did not change. The design is thus a controlled quasi-experimental one. Subjects were not randomized. Key dependent variables are whether each individual had any specialty mental health visits in a year; the number of visits; and the proportion of users exceeding eight visits in a year. Key explanatory variables include demographic variables and indicators for patient diagnoses and their intervention status (time-period, study group). DATA COLLECTION/EXTRACTION METHODS: Claims data were aggregated to create analytic files with one record per member per year, with variables reporting demographic characteristics and mental health service use. PRINCIPAL FINDINGS: After controlling for secular trends at the other division, the division which changed gatekeeping model eventually experienced an increase in the proportion of enrollees receiving specialty mental health treatment, of 0.5 percentage point. Similarly, there was an increase of about 0.6 annual visits per user, concentrated at the low end of the distribution. These changes occurred only in the second year after the gatekeeping changes. CONCLUSIONS: The results of this study suggest that the gatekeeping changes did lead to increases in utilization of mental health care, as hypothesized. At the same time, the magnitude of the increase in access and mean number of visits that we found was relatively modest. This suggests that while the change from face-to-face specialty gatekeeping to call-center intake does increase utilization, it is unlikely to overwhelm a system with new demand or create huge cost increases.
author Hodgkin, Dominic
Merrick, Elizabeth L
Horgan, Constance M
Garnick, Deborah W
McLaughlin, Thomas J
author_facet Hodgkin, Dominic
Merrick, Elizabeth L
Horgan, Constance M
Garnick, Deborah W
McLaughlin, Thomas J
author_sort Hodgkin, Dominic
title Does Type of Gatekeeping Model Affect Access to Outpatient Specialty Mental Health Services?
title_short Does Type of Gatekeeping Model Affect Access to Outpatient Specialty Mental Health Services?
title_full Does Type of Gatekeeping Model Affect Access to Outpatient Specialty Mental Health Services?
title_fullStr Does Type of Gatekeeping Model Affect Access to Outpatient Specialty Mental Health Services?
title_full_unstemmed Does Type of Gatekeeping Model Affect Access to Outpatient Specialty Mental Health Services?
title_sort does type of gatekeeping model affect access to outpatient specialty mental health services?
publisher Blackwell Science Inc
publisher_facet Blackwell Science Inc
publishDate 2007
url https://ncbi.nlm.nih.gov/pmc/articles/PMC1955246/
https://ncbi.nlm.nih.gov/pubmed/17355584
https://ncbi.nlm.nih.govhttp://dx.doi.org/10.1111/j.1475-6773.2006.00609.x
_version_ 1760490631045578752

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