Davis George E, Lowell Walter E
Augusta Mental Health Institute, Maine 04332, USA.
Am J Med Qual. 2002 Sep-Oct;17(5):200-5. doi: 10.1177/106286060201700508.
The authors, using State Mental Health Agency (SMHA) data from the National Association of State Mental Health Program Directors' Research Institute, show that the amount of state hospital (SH) expenditures is related to suicide rate (SR) as well as to cost per capita for mental health care. The relationship is much stronger for cost per capita especially when the range of SH expenditures is 31-55%, or 43 +/- 12%, of total expenditures. This article hypothesizes that maximum system efficiency occurs when the funding structure of the delivery system reflects a 57%:43% (community [C]/SH) ratio. This ratio was the mean for the 50 states of the United States in 1997, when the national mean SR was 13 per 100,000 of general population. This ratio is identical to the C-to-SH inpatient bed ratio derived theoretically in a previously reported study focusing on fractal (self-similar on all scales) demand for mental health services. The potential for national saving with the redistribution of funding may be as high as $4.5 billion per year, or 23% of SMHA expenditures.
作者利用国家心理健康项目主任协会研究所的州心理健康机构（SMHA）数据表明，州立医院（SH）支出金额与自杀率（SR）以及心理健康护理人均成本相关。这种关系在人均成本方面更为显著，尤其是当SH支出范围为总支出的31% - 55%，即43% +/- 12%时。本文假设，当提供系统的资金结构反映出57%:43%（社区[C]/SH）的比例时，系统效率达到最高。该比例是1997年美国50个州的平均值，当时全国平均自杀率为每10万普通人口中有13例。这个比例与之前一项关于心理健康服务分形（在所有尺度上自相似）需求的研究中理论推导得出的C与SH住院床位比例相同。通过资金重新分配实现国家节约的潜力可能高达每年45亿美元，占SMHA支出的23%。
