This Research Scientist Development Award proposal focuses on the impact of state and national health care reforms on the provision of mental health services. Building on previous work on privatization and physician payment reform, proposed investigations aim to: 1)study the effects of reforms in Massachusetts resulting from a public policy of privatization and involving closure of state hospitals and transfer of care for severely mentally ill persons to community general and private psychiatric hospitals (years 1-2); 2) analyze patterns of utilization of mental health services by elderly and disabled under Medicare and investigate the impact of the introduction of the Medicare physician free schedule (e.g., RBRVS) on practices and patterns of utilization of mental health services (years 2-4) and 3) develop a program of research with a private insurer in order to assess the impact of future national health care reforms on patterns and outcomes of mental health care under different financing arrangements (years 3-5). These investigations will involve: acquiring person-level data; investigating the interaction of general health sector policies with mental health care; assessing provider treatment responses to changes in financing; and analysis of the impact of different approaches to health care reform. Issues of access, utilization, and outcomes will be studied. Using primarily data that are already collected or available, further methods for analysis of claims and tracking data will be developed in consultation with multidisciplinary teams. A program of career development is outlined based on directed advanced study, pending projects, proposed project collaborations and consultation with senior investigators at Harvard University.
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