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The Administrative Control System of Substance Abuse Managed Care

Authors

  • Michael R. Sosin

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    • Address correspondence to Michael R. Sosin, The School of Social Service Administration, The University of Chicago, 969 E. 60th St., Chicago, IL 60637.


  • The data for this paper were collected under grant number DA11001 from the National Institute for Drug Abuse. The conclusions are those of the author. I would like to acknowledge the research assistance of Courtenay Savage and Melissa Walker and the comments of Thomas D'Aunno, Julia Henly, and two anonymous reviewers.

Abstract

Objective. This article searches for the dimensions of the administrative structures in outpatient substance abuse managed care that control the behavior of agency providers. It also ascertains how these dimensions, and several financial mechanisms, affect key aspects of the providers services: the average number of sessions of care that are delivered, the rate of completion of care, and the (estimated) rate at which clients control their substance use.

Data Sources. The data were collected in 1999 for this investigation.

Study Design. These data come from a nationally representative, cross-sectional sample of individual contracts between outpatient drug treatment providers and the Behavioral Health Managed Care Organizations (BHMCOs) that are empowered to regulate the delivery of services. Provider responses are analyzed here.

Data Collection Methods. Factor analyses at a contract level examine the structural dimensions of the control system. Multivariate analyses at the same level rely on generalized linear models to predict the dependent variables by the structural dimensions and financial mechanisms.

Findings. The factor analyses suggest that there are six multiple variable structural dimensions. The multivariate analyses suggest that the dimension that mandates follow-up of discharged clients tends to relate to more sessions of care and perhaps a higher rate of service completion. Most other dimensions are found to relate to fewer sessions of care, lower rates of service completion, or lower rates of control of substance abuse. No structural dimension relates to all dependent variables. Financial mechanisms evince varying relations to the sessions of care. They rarely relate to the other dependent variables.

Conclusion. The results generally suggest that providers, payers, or policymakers might affect service provision by selecting BHMCOs that stress particular structural dimensions and financial mechanisms. However, managed care contracts most heavily rely on structural dimensions that restrict treatment sessions and fail to predict superior client outcomes.

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