Provan K G, Milward H B
College of Business and Economics, University of Kentucky.
J Health Polit Policy Law. 1994 Winter;19(4):865-94. doi: 10.1215/03616878-19-4-865.
Despite strong interest by health care services researchers in studying community-based service delivery to persons with severe mental illness, few understand the relationship between the structure of public funding and differences in how mental health care delivery systems are organized. In particular, the structure of public funding may have a substantial effect on the nature and extent of integration among the various service providers that comprise a community's delivery network. Such an understanding is critical if mental health policymakers are to use their influence on funding to guide the structure of service delivery. To investigate this issue, we compared community mental health care systems in four U.S. cities. We found that services will be integrated regardless of the structure of public funding but that the structure of integration among providers will be affected. Specifically strong fiscal control by the state is conducive to delivery systems that are integrated through the core mental health care agency in a community, whereas weak fiscal control is more likely to result in decentralized integration among system providers.
尽管医疗服务研究人员对研究针对严重精神疾病患者的社区服务提供有着浓厚兴趣，但很少有人了解公共资金结构与精神卫生保健服务提供系统组织方式差异之间的关系。特别是，公共资金结构可能对构成社区服务提供网络的各类服务提供者之间整合的性质和程度产生重大影响。如果精神卫生政策制定者要利用其在资金方面的影响力来指导服务提供结构，那么这种理解至关重要。为了调查这个问题，我们比较了美国四个城市的社区精神卫生保健系统。我们发现，无论公共资金结构如何，服务都会进行整合，但提供者之间的整合结构会受到影响。具体而言，州政府的严格财政控制有利于通过社区核心精神卫生保健机构进行整合的服务提供系统，而财政控制薄弱则更有可能导致系统提供者之间的分散整合。
