Public sector managed care: a comparative evaluation of substance abuse treatment in three counties

A study of publicly funded substance abuse treatment systems compared MidState, a county that reorganized its treatment system using managed care principles, to two other California counties that took different approaches, NorthState and SouthState. It was hypothesized that MidState would have better outcomes due to its emphasis on quality of care.

This natural experiment compared the 'experimental' county, MidState, to two 'control' counties, assessing client outcomes following treatment. Administrative and historical exigencies that may affect system differences were explored in interviews with treatment program managers and staff.

Comparison counties were selected using treatment system and county census data, maximizing similarities to enhance internal validity.

Adult clients (n = 681) were interviewed when beginning treatment and 12 months later (81% response rate). In addition, 50 treatment program managers and staff members across the three counties were interviewed during the year of client recruitment.

Client interviews assessed functioning in the seven Addiction Severity Index domains-alcohol, drug, psychiatric, legal, employment, medical and family/social.

Outcomes (differences between baseline and 12 month composite scores) did not differ between counties in six of seven domains; in the seventh, psychiatric functioning, SouthState had better outcomes than MidState. Staff interviews indicated generally similar treatment strategies across counties, with MidState supplying greater oversight and performance standards.

Managed care in public sector treatment generally did not result in poorer outcomes. Future attention in MidState to the barriers to successful implementation of individualized treatment, and to dual diagnosis treatment, might bring more positive results.