Using data from Southeastern Medicaid programs, this paper finds that, unlike with primary care, the impact of managed care settings on mental health provider satisfaction is minimal.  The authors note that variables relevant to everyday working conditions had important effects on job satisfaction. 

Isett, K. R., A. R. Ellis, et al. (2009). Managed care and provider satisfaction in mental health settings. Community Ment Health J., 45(3), 209-21. http://www.ncbi.nlm.nih.gov/pubmed/19002581 

Authors: Kimberley R. Isett, Alan R. Ellis, Sharon Topping, Joseph P. Morrissey.

This study examined the effects of prior authorization for second-generation anti-psychotic and anti-convulsant on utilization, discontinuations in therapy, and pharmacy costs among Maine Medicaid beneficiaries with bipolar disorder.  The study found that the prior authorization policy resulted in an 8 percent the prevalence of use of non-preferred second generation drugs but did not increase the rate of use for preferred drugs or the rate of switching.  The policy reduced total pharmacy reimbursements for bipolar disorder by $27 per patient during the eight-month policy period but the hazard rate of treatment discontinuation was higher than during the pre-policy period.  The authors conclude that the use of prior authorization in Maine may have increased patient risk without significant cost savings to the Medicaid program. 

Zhang, Y., A. S. Adams, et al. (2009). Effects of prior authorization on medication discontinuation among Medicaid beneficiaries with bipolar disorder. Psychiatric Services, 60(4), 520-7.  DOI: 10.1176/appi.ps.60.4.520 http://psychservices.psychiatryonline.org/cgi/content/abstract/60/4/520 

Authors: Yuting Zhang, Alyce S. Adams, Dennis Ross-Degnan, Fang Zhang, Stephen B. Soumerai. 

This white paper by Milliman Inc. analyzes the Mental Health Parity and Addiction Equity Act of 2008, focusing on effects of the parity legislation on individuals, health care plans, managed behavioral health care organizations (MHBOs) and other key stakeholders. 

Download the white paper from Milliman: http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/preparing-parity-investing-mental-WP05-01-09.pdf 

This article examines the effects of economic policy on the provision of psychiatric hospital care.  The authors discuss the shift from long-stay public hospitals to private acute care and the cost shifting from states to federal and private payers through managed care.  The authors note that the result has been a shortage of psychiatric beds but also a better continuum of care, increased specialization within hospital psychiatry units, and an increased emphasis on patient choice and recovery.  

Sharfstein, S. S. and F. B. Dickerson (2009). Hospital psychiatry for the twenty-first century. Health Affairs, 28(3), 685-8. DOI: 10.1377/hlthaff.28.3.685 http://content.healthaffairs.org/cgi/content/abstract/28/3/685 

Authors: Steven S. Sharfstein, Faith B. Dickerson.

This article shows that, in spite of the increasing similarities between mental health care and general health care delivery and financing, important differences remain in patterns of spending growth.   

Frank, R. G., H. H. Goldman, et al. (2009). Trends in mental health cost growth: an expanded role for management? Health Affairs, 28(3), 649-59. DOI: 10.1377/hlthaff.28.3.649 http://content.healthaffairs.org/cgi/content/short/28/3/649 

Authors: Richard G. Frank, Howard H. Goldman, Thomas G. McGuire.

This study examined drug and alcohol users without diagnosed substance abuse disorders within the context of HMO primary care.  The authors found "a prevalence of 7.5% for hazardous drinking and 3.2% for drug use in primary care (10% had at least one of the two problems). Hazardous drinkers and drug users had heightened prevalences for eight medical conditions, including costly conditions such as injury and hypertension, and psychiatric conditions. Medical costs for the year examined were not higher, except for those who also had psychiatric conditions".  They study concludes that "the prevalence of hazardous drinking and drug use was similar to hypertension and diabetes. Hazardous drinkers and drug users' heightened medical conditions, especially those related to alcohol and drug abuse, indicate that screening and brief intervention at this lower threshold of hazardous drinking and drug use will detect individuals with health risks sooner. Optimal treatment and prevention of some medical disorders may require identification and intervention of underlying hazardous alcohol or drug use."

Mertens, J. R., Weisner, C., Ray, G. T., Fireman, B., & Walsh, K. (2005). Hazardous drinkers and drug users in HMO primary care: prevalence, medical conditions, and costs. Alcohol Clin Exp Res, 29(6), 989-998. http://www.alcoholism-cer.com/pt/re/alcoholism/abstract.00000374-200506000-00009onclick= 

Authors: Jennifer R. Mertens, Constance Weisner, Thomas G. Ray, Bruce Fireman, Kevin Walsh.