The Impact of Risk Shifting and Contracting on Mental Health Service Costs in California

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...

Full description

Saved in:
Bibliographic Details
Published in:Inquiry (Chicago) 2000, Vol.37 (2), p.121-133
Main Authors: Scheffler, Richard M., Wallace, Neal T., Hu, Teh-Wei, Garrett, A. Bowen, Bloom, Joan R.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Ambulatory Care - economics
California
Cost Control
Cost efficiency
Cost reduction
Decentralization
Efficiency
Financial risk
Funding
Health Care Costs - statistics & numerical data
Health Care Costs - trends
Health care expenditures
Health care policy
Hospitalization - economics
Humans
Local Government
Medicaid
Mental health
Mental health services
Mental Health Services - economics
Mental Health Services - organization & administration
Middle Aged
Models, Econometric
Policy Making
Politics
Public Health Administration - economics
Regression Analysis
Revenue
Risk
Risk Sharing, Financial - organization & administration
Social Responsibility
State hospitals
Statistical analysis
Studies
User costs
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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.
ISSN:0046-9580
1945-7243