Effects of Mental Health Carve-Outs on the Treatment of Depression in Primary Care


Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

3207.0: Monday, December 12, 2005 - 12:30 PM

Abstract #100876

Effects of Mental Health Carve-Outs on the Treatment of Depression in Primary Care

Ashley Aull Dunham, MSPH, Public Policy Program, Health Policy Specialization, UNC-Charlotte, 528 Maupin Avenue, Salisbury, NC 28144, 704-636-9315, adunham@uncc.edu and William P. Brandon, PhD, MPH, Department of Political Science, University of North Carolina-Charlotte, 9201 University City Boulevard, Charlotte, NC 28223.

The research objectives are to discover (1) the effects of a mental health carve-out on primary care physician prescribing and referral patterns in treating Medicaid patients with depression and (2) the efficacy of the primary care philosophy of treating common mental along with physical conditions when faced with this economic barrier. (3) It will test the agent-principal and wealth maximization economic theories of physician behavior.

Primary care is currently conceptualized as responsible for a wide range of care, including primary mental health care. However, barriers threaten primary care physicians' ability to provide optimum health care. In particular, mental health carve-outs that deny reimbursement for mental health care to primary care physicians may make achievement of primary care best practice models impossible. Although previous research has focused on the effect of mental health carve-outs on the quantity and quality of care and treatment costs, no one has studied the effect of this financial disincentive on provision of primary care depression treatment in Medicaid.

The quasi-experimental design involves an intervention and control county and pre-post measures for each. Using logit and hazard models, an examination of existing claims data will reveal changes in the probability and risk of antidepressant prescription drug use and mental health referrals. Unstructured, exploratory interviews will elicit physicians' personal experiences with the carve-out, conceptualizations of primary care, and interactions between reimbursement rules and best depression treatment practices.

Learning Objectives:

At the conclusion of the session, learners will be able to

Recognize physician perceptions of the importance of primary care depression treatment.
Articulate the effect of mental health carve-outs on the treatment of depression in a Medicaid population.
Identify how financial barriers may prevent primary care physicians from implementing best-practice guidelines for depression.
Describe physician beliefs regarding the importance of primary care, and how financial guidelines may prevent them for practicing medicine that considers both the mind and body.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation

Assessing and Treating Mental Illness in Primary Care

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA