Scheffler R, Zhang A, Snowden L
Health Policy and Management Division of the School of Public Health, University of California at Berkeley, 94720-7360, USA.
Adm Policy Ment Health. 2001 Nov;29(2):129-43. doi: 10.1023/a:1014336530490.
Decentralization of California's public mental health system under program realignment has changed the utilization and cost of community-based mental health services. This study examined a sample of 75,951 users, representing 1.5 million adults who visited California's public mental health services during a 6-year period (FY 1988-1990 and FY 1992-1994). Regression analysis was performed to examine cost and utilization reduction over time, across regions, and across psychiatric diagnoses. Overall utilization and cost of community-based mental health services dropped significantly after the implementation of realignment. They were significantly lower for (a) 24-hour services in the urban industrialized Southern Region and (b) outpatient services in the agricultural Central Region of the state. Users diagnosed with mood disorders took a greater portion, but were associated with significantly less treatment and cost than other users in the post-realignment period. When local communities bear the financial risks and rewards, they find more efficient methods of delivering community-based mental health services.
加利福尼亚州公共心理健康系统在项目调整下的权力下放改变了社区心理健康服务的利用率和成本。本研究调查了75951名使用者的样本，这些样本代表了在6年期间（1988财年至1990财年以及1992财年至1994财年）访问加利福尼亚州公共心理健康服务的150万成年人。进行回归分析以研究随着时间推移、跨地区以及跨精神疾病诊断的成本和利用率降低情况。在调整实施后，社区心理健康服务的总体利用率和成本显著下降。在（a）工业化城市南部地区的24小时服务以及（b）该州农业化中部地区的门诊服务方面，它们显著更低。被诊断患有情绪障碍的使用者占比更大，但在调整后时期，与其他使用者相比，他们接受的治疗显著更少且成本更低。当当地社区承担财务风险和回报时，他们会找到更有效的提供社区心理健康服务的方法。
