Financing and Use of Public Mental Health Services and Costs Among the Seriously Mentally Ill
- Presenter:
Chair: Glenn Blomquist; Discussant: Mark Dickie Tue June 6, 2006 8:00-9:30 Room 313
Background: Research has shown that how mental health services are financed affects the types and amounts of services provided. Most of these studies have considered differences between fee-for-service (FFS) providers and capitated provider groups. To our knowledge, no published study has examined the characteristics of contractual relationships typical of county-based public mental health systems in California.
Objectives: To analyze the relationship between financing and service delivery in a large community public mental health system among three provider types: county providers, county-contracted providers, and FFS providers.
Research Design: We examined outpatient services, hospitalizations and use of emergency services, and costs for persons treated for schizophrenia, bipolar disorder, or major depression in San Diego County in fiscal years 2002-2003 and 2003-2004 (N=20,562). We assigned clients to one of the three provider types based on where they received the majority of their medication management services. Costs were determined by detailed examination of contracts and cost reports, and were linked to individual level encounter data. Multivariate models were used to adjust for a number of socio-demographic and clinical characteristics expected to affect service use.
Results: Outpatient service use was greatest, and total costs lowest, among clients of county-contracted providers. Clients of FFS providers were more likely than clients of county or county-contracted providers to be admitted to an acute psychiatric facility.
Conclusions: Mental health services use and costs in this population are related to provider type.
