Schlesinger M, Dorwart R
N Engl J Med. 1984 Oct 11;311(15):959-65. doi: 10.1056/NEJM198410113111506.
The mental-health system in the United States is undergoing marked "privatization"--a growth in the importance of both private nonprofit and for-profit providers. Analyzing data collected in earlier surveys, we found that the type of ownership was linked to a number of important aspects of institutional performance: (1) private facilities, both for profit and not-for-profit, are more likely to screen out nonpaying patients than are government-owned providers; (2) services provided under public auspices are more expensive than those provided in private institutions; and (3) compared with private nonprofit facilities, for-profit providers devote fewer staff resources to patient care and offer fewer services with community-wide benefits. We conclude that ownership affects the organizational behavior of mental-health facilities. The contemporary shift from public to private provision of mental-health care raises important questions about ensuring adequate access to care, maintaining the supply of needed services, and adapting systems of reimbursement and regulation to the heterogeneous motivations of providers operating under different forms of ownership.
美国的心理健康系统正在经历显著的“私有化”——私人非营利性和营利性服务提供商的重要性不断增加。通过分析早期调查收集的数据，我们发现所有权类型与机构绩效的多个重要方面相关：（1）营利性和非营利性的私人机构比政府所有的机构更有可能筛选出无支付能力的患者；（2）在公共支持下提供的服务比在私人机构提供的服务更昂贵；（3）与私人非营利性机构相比，营利性服务提供商投入到患者护理的人力资源更少，提供的具有社区广泛效益的服务也更少。我们得出结论，所有权会影响心理健康机构的组织行为。当代心理健康护理从公共提供向私人提供的转变，引发了关于确保充足的护理可及性、维持所需服务的供应以及使报销和监管系统适应不同所有权形式下运营的服务提供商的异质动机等重要问题。
