Objective:Reducing overuse of second-generation antipsychotics among Medicaid-enrolled children is a national priority, yet little is known about how service organization affects use. This study ...compared differences in second-generation antipsychotic utilization among Medicaid-enrolled children across fee-for-service, integrated managed care, and managed behavioral health carve-out organizational structures.Methods:Organizational structures of Medicaid programs in 82 diverse counties in 34 states were categorized and linked to child-level cross-sectional claims data from the Medicaid Analytic Extract covering fiscal years 2004, 2006, and 2008. To approximate the population at risk of antipsychotic treatment, the sample was restricted to stimulant-using children ages three to 18 (N=419,226). The sample was stratified by Medicaid eligibility group, and logistic regression models were estimated for probability of second-generation antipsychotic use. Models included indicators of county-level organizational structure as main predictors, with sequential adjustment for personal and county-level covariates.Results:With adjustment for person-level covariates, second-generation antipsychotic use was 31% higher among youths in foster care in fee-for-service counties than for youths in counties with carve-outs (odds ratio OR=1.69, 95% confidence interval CI=1.26–2.27). Foster care youths in integrated counties had the second highest adjusted odds (OR=1.31, CI=1.08–1.58). Similar patterns of use also were found for youths eligible for Supplemental Security Income but not for those eligible for Temporary Assistance for Needy Families. Differences persisted after adjustment for county-level characteristics.Conclusions:Carve-outs, versus other arrangements, were associated with lower second-generation antipsychotic use. Future research should explore carve-out features (for example, tighter management of inpatient or restricted access, as well as care coordination) contributing to lower second-generation antipsychotic use.
In even the most market-oriented economies, most economic transactions occur not in markets but inside managed organizations, particularly business firms. Organizational economics seeks to understand ...the nature and workings of such organizations and their impact on economic performance. This landmark book assembles the leading figures in organizational economics to present the first comprehensive view of both the current state of research in this fast-emerging field and where it might be headed.
The Handbook of Organizational Economicssurveys the major theories, evidence, and methods used in the field. It displays the breadth of topics in organizational economics, including the roles of individuals and groups in organizations, organizational structures and processes, the boundaries of the firm, contracts between and within firms, and more.
The defining book on the subject,The Handbook of Organizational Economicsis essential reading for researchers and students looking to understand this emerging field in economics.
Presents the first comprehensive treatment of organizational economics Features contributions by leaders in the field Unifies and extends existing literatures Describes theoretical and empirical methods used today
This article shares findings from a study of the public behavioral health care system in the District of Columbia, including the prevalence of mental health disorders and substance use, the ...organization and financing of public behavioral health services, utilization of public behavioral health services, and priorities for improvement. The authors' analyses found that prevalence of mental health conditions resembles patterns nationally, among both adults and youth. Substance use disorders are more prevalent among adults and comparatively lower for the youth population, compared to national patterns. Potentially 60 percent of adults and 72 percent of adolescents enrolled in Medicaid managed care may have unmet need for depression services. Based on claims data, 45 percent of children and 41 percent of adults enrolled in Mental Health Rehabilitation Services programs have gaps in care that exceed six months during a 12-month period. Participants in focus groups and stakeholder interviews highlighted such challenges as gaps in care and difficulties in coordination of care for particular populations and services. High-level priorities include reducing unmet need for public mental health care, tracking and coordinating care, improving the availability and accessibility of substance use treatment services, and upgrading the data infrastructure.
Ordover, Saloner, and Salop (1990) claim to show that vertical mergers can increase final product price. While the results are not very robust, they seem to show that, even with fixed proportions, ...vertical mergers can have deleterious effects on welfare. In effect, Ordover, Saloner, and Salop (OSS) show that higher downstream prices will result if the integrated firm can commit not to undercut the rival's price. According to Reiffen, absent such commitment ability, vertical integration is ineffective. Unless some causal nexus between vertical integration and the ability to commit to a pricing strategy is demonstrated, it is difficult to see how the OSS results are related to vertical integration at all. In a reply, Ordover, Saloner, and Salop show that the result in OSS, that vertical foreclosure can lead to the raising of intermediate input prices and downstream prices to the disadvantage of the unintegrated downstream rival and of final consumers, does not rely on the ability of the integrated firm to make price commitments.
A method for quantitating flow velocities is presented. The technique tags multiple boli of magnetization in transit across a thick selection slab using rf inversion pulses. Results in phantoms and ...in vivo demonstrate that the method is robust and can provide velocity determinations in tortuous vessels.
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