The 130th Annual Meeting of APHA

Abstract #45200

Joanna Volpe-Vartanian, MS, LICSW and Dominic Hodgkin, PhD. Schneider Institute for Health Policy, Heller Graduate School, Brandeis University, MS 35,415 South St, Waltham, MA 02454, (617) 734-5108, jvolpevartanian@aol.com

Mental health and substance abuse services, or behavioral health services, are increasingly carved out of medical plans and instead provided by managed behavioral health care organizations under a separate contract. Proponents of 'carve-outs' describe the potential for not only curbing unnecessary utilization but also improving access and maintaining quality. Opponents are concerned about how financial incentives to suppress costs may lead to undertreatment, adversely impacting quality of care for all patients, particularly the seriously ill. It is worth considering whether carved-out arrangements may have differential effects on women's behavioral health care delivery. There are well-documented epidemiologic disparities between genders, with major depression, anxiety disorders, eating disorders, and co-morbid alcohol disorders being the disorders which are more common in women. Women's treatment needs differ, as do their patterns of help-seeking. Women's care is often more fragmented during their childbearing years as they see both obstetrician-gynecologists and primary care physicians. Given women's differential behavioral health characteristics and needs, there may be gender differences in how carve-outs affect: 1) access to care, 2) duration, intensity, and/or treatment type, and 3) treatment response. The authors reviewed recent empirical studies of the impact of carve-outs on utilization. Only a minority reported whether impacts differed for women, but among those studies some gender differences were statistically significant. It is recommended that closer attention be paid to the interaction between carve-outs and women's behavioral health needs to better understand the extent to which access to appropriate treatment is actually increased.

Learning Objectives: At the end of the session participants will be able to

• identify key points from the literature on the impact of carve outs on behavioral health care,
• describe gender differences in prevalence rates of particular behavioral health disorders, in help-seeking behaviors, and in treatment needs, and
• discuss how carve out arrangements may differentially impact women's access to and utilization of services given different needs.

Keywords: Carve Outs, Gender

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.