The Effect of Medicaid Policies on the Diagnosis and Treatment of Children's Mental Health Problems in Primary Care
研究利用三个州的医疗补助数据，评估管理式医疗政策如何影响初级保健医生对儿童心理疾病的诊断与治疗，发现健康维护组织减少了诊断和非药物治疗，而初级保健病例管理则将诊疗转向精神科专家。
Primary care physicians play a substantial role in diagnosing and treating children's mental health disorders, but Medicaid managed care policies may limit these physicians' ability to serve low-income children. Using data from the universe of Medicaid recipients in three states, I evaluate how Medicaid managed care policies impact primary care diagnosis and treatment of children's mental health disorders. Specific policies examined include the presence of a behavioral carve-out, traditional health maintenance organization, or primary care case management program. To alleviate concerns of endogenous patient sorting, my preferred identification strategy uses variation in Medicaid policy penetration to instrument for individual plan choices. I show that while health maintenance organizations reduce diagnosis and non-drug treatment of mental health disorders, primary care case management program policies shift in diagnosis and treatment from within primary care to specialist providers such as psychiatrists, where serious mental health conditions are more likely to be identified.