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Managed Care and Systems Cost-Effectiveness

Treatment for Depression

Bibliographic Data

ID9104616
AuthorsMargarita Alegria (0000-0003-2241-707X, Harvard University, corresponding author), Robert G Frank (0000-0003-1551-7072, Harvard University), Richard Frank (0000-0001-5927-1217), Thomas Mcguire (Harvard University)
Year2005
Volume43
Issue12
Pages1225-1233
Publication date2005-12-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/01.mlr.0000185735.44067.42
PMID16299434
OpenAlexW2081682936
LanguageEN
Citations received1
References cited33

OBJECTIVE: The objective of this study was to assess the change in system cost-effectiveness of depression treatment after the introduction of managed care. DATA SOURCES/STUDY SETTING: The study population consisted of adults ages 18 to 69 living in low-income areas of Puerto Rico. STUDY DESIGN: Using a random probability sample of the population, 2 waves (1992-1993, 1993-1994) of data were collected before implementation of managed care and one wave (1996-1998) after implementation. Composite International Diagnostic Interview (CIDI)-generated depression diagnoses and Centers for Epidemiologic Studies-Depression (CES-D) scale of depressive symptoms scales were used to assess depression. DATA COLLECTION/EXTRACTION METHODS: Effectiveness of treatment was defined by guideline standards and experts' assessment of the probability of remission resulting from treatment. Costs were measured by assigning representative prices to each treatment modality. Difference-in-difference (D-in-D) estimators were used to assess the impact of managed care on the effectiveness and costs of treating depression at the system level for the entire population. PRINCIPAL FINDINGS: System cost-effectiveness improved slightly after the introduction of managed care, with diminished costs but no significant improvements in effectiveness. CONCLUSION: Cost-effectiveness can be measured at the population level to assess system changes. Additional incentives and system realignments beyond utilization review and diminished treatment costs are necessary to attain a more cost-effective system of care

CIDI · Cost effectiveness · Environmental health · Health care · Managed care · Population · Risk analysis (engineering) · Medicine · Mental Health Treatment and Access · Patient Satisfaction in Healthcare · Primary Care and Health Outcomes

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  • Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI)

    Open Access•Hans-Ulrich Wittchen•Journal of Psychiatric Research•1994

  • The Epidemiology of Major Depressive Disorder

    R C Kessler, Patricia Berglund et al.•JAMA•2003

  • The Quality of Care for Depressive and Anxiety Disorders in the United States

    Alexander S Young, Ruth Klap et al.•Archives of General Psychiatry•2001

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    Philip S Wang, Patricia Berglund et al.•Journal of General Internal…•2000

  • Impact of Disseminating Quality Improvement Programs for Depression in Managed Primary Care

    Kenneth B Wells, Cathy Sherbourne et al.•JAMA•2000

  • Interaction terms in logit and probit models

    Open Access•Chunrong Ai, Edward C Norton•Economics Letters•2003

  • The Impact of Managed Care on the Use of Outpatient Mental Health and Substance Abuse Services in Puerto Rico

    Open Access•Margarita Alegria, Thomas Mcguire et al.•INQUIRY The Journal of Health…•2001

  • Changes in Access to Mental Health Care Among the Poor and Nonpoor

    Margarita Alegria, Thomas Mcguire et al.•American Journal of Public Health•2001

  • The use of outpatient mental health services in the United States and Ontario

    S Katz, S J Katz et al.•American Journal of Public Health•1997

  • "Managing" the poor

    Jeff Maskovsky•Medical Anthropology•2000

Unique citing works1
Citations per year0,06
Citation span2008 - 2008 (1)
Citation velocityhistorical
Highly citedNo
Citation typesNeutral: 1
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