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Shepard, D., Daley, M., Ritter GA., Hodgkin, D., & Beinecke, R. (2002) Managed care and the quality of substance abuse treatement. The Journal of Mental Health Policy and Economics, 5, 163-174. Carve-out programs had mixed effects on the qualidy of substance abuse treatment. While one of the three measures (readmission rates) deteriorated, two improved (access and continuity).