This dissertation research explores a critical issue in mental health services research: the relationship between economic incentives and quality of care. Determining the relationship between financing arrangements and consumer outcomes is vital to understanding the effects of rapid changes in mental health service delivery, and critical to improving health care quality. Drawing from Donabedian's conceptual model of quality care, this study will characterize the financial arrangements or components of different mental health care payment plans (i.e., co-payment, session limits, capitation, risk assessment, utilization review, and treatment and medication sessions) and explore their relationship to consumer outcomes (i.e., levels of functioning and goal attainment). This study explores the following aims:
Aim 1) Assess the variability in major components of mental health care plans among outpatient consumers of mental health services.
Aim 2) Examine the relationship between the components of managed mental health care financing arrangements and attainment of consumer outcomes. In contrast with studies conducted single plan or demonstration project, this study decomposes the financial arrangements of different benefit packages by drawing on data from a service agency that has numerous external contracts, thereby taking advantage of a natural control for organizational differences. Data concerns 250 subjects whose cases were closed in 1995, who were diagnosed with depression, and who received at least one counseling and medication treatment session. Data are analyzed both descriptively and using two-stage least squares regression. This dissertation study responds to the need to better understand the organizational aspects of health care and the effects of financial and other incentives on the quality of mental health care and service delivery.
