A Conceptual Framework for Evaluating the Intersystem Impacts of Managed Behavioral Health Care: Report on a Roundtable Discussion
Howard H. Goldman, MD, Ph.D. & Joseph P. Morrissey
This essay presents an "open systems" perspective on current alcohol, drug abuse and mental health (ADM) reforms as a conceptual framework for evaluating their intersystem impacts. The framework focuses both on reforms within the ADM system itself (managed behavioral health care, MBHC, in particular) and those coming from outside that system (such as welfare reform). It is based on a review of the literature and discussions among a group of consultants attending a meeting held in November 1995. The first part of the report describes recent trends in MBHC and reviews some historic precedents of cost shifting following major reforms in the financing of mental health services. The second part examines an open system framework for understanding the impact of these changes on the ADM service system. The third part reviews some of the specific ways in which cost shifting between sectors may occur under MBHC arrangements.