Scheffler R M, Wallace N T, Hu T W, Garrett A B, Bloom J R
School of Public Health, University of California, Berkeley 94720-7360, USA.
Inquiry. 2000 Summer;37(2):121-33.
This paper identifies the impact of "program realignment," a 1991 California state policy that significantly enhanced local governments' financial risk and programmatic authority for public mental health services, on treatment costs per user, and on the mix of inpatient and outpatient service costs. The study employs a natural pre-realignment and post-realignment design using the 59 California local mental health authorities (LMHAs) as the unit of analysis over a seven-year period spanning policy implementation. Total treatment and inpatient cost per user decreases and outpatient cost per user increases after program realignment. Higher levels of contracting with private providers tend to enhance this trend, while risk for institutional services reduces user costs uniformly. Financial and programmatic decentralization can enhance cost efficiency in treatment, while promoting substitution of outpatient services for inpatient services. Local conditions such as risk and contracting determine the extent of the policy response.
本文确定了1991年加利福尼亚州的一项政策“项目重新调整”对每位使用者的治疗成本以及住院和门诊服务成本组合的影响。该政策显著增加了地方政府在公共心理健康服务方面的财务风险和项目权力。该研究采用了自然的调整前和调整后设计，以加利福尼亚州的59个地方心理健康机构（LMHA）作为分析单位，涵盖了政策实施后的七年时间。项目重新调整后，每位使用者的总治疗成本和住院成本下降，而每位使用者的门诊成本增加。与私人提供者签订的合同水平较高往往会强化这一趋势，而机构服务的风险则会统一降低使用者成本。财政和项目权力下放可以提高治疗的成本效率，同时促进门诊服务替代住院服务。风险和合同等当地情况决定了政策应对的程度。
