Am J Psychiatry 1991; 148:204-210
Copyright © 1991 by American Psychiatric Association
A national study of psychiatric hospital care
RA Dorwart, M Schlesinger, H Davidson, S Epstein and C Hoover
Harvard University Division of Health Policy Research and Education, Malcolm Wiener Center for Social Policy, John F. Kennedy School of Government, Cambridge, MA 02138.
BACKGROUND: The delivery system for psychiatric inpatient services in the
United States has changed dramatically over the past 30 years, undergoing a
marked privatization. METHOD: To assess the effect of changes in ownership
and types of inpatient settings on the structure of the mental health
services system, the authors surveyed a national sample of nonfederal
mental health facilities in 1988. RESULTS: Comparing their data to those of
earlier surveys, they found that a decline in the number of patients per
staff occurred in most settings over the last decade, suggesting that this
aspect of quality of care may have improved. They observed important
ownership-related differences in 1988 in diagnostic mix (e.g., more
schizophrenia treated in public facilities than in private ones) and in
payer source (e.g., more third-party revenues in public facilities than
occurred in the past). CONCLUSIONS: There was a significant interaction
between ownership form and type of facility, suggesting that the type of
inpatient setting, ownership, and the relation between the two should be
considered in assessing the impact of privatization on the accessibility of
health care available for the mentally ill. The authors found that the
increase in private psychiatric hospitals has widened the availability and
choice of treatment facilities for those with private funding sources
(especially children and adolescents) but has not had a similar effect in
increasing sources of care for the seriously mentally ill dependent upon
public financing.
