The Role of the Public Sector in Ensuring Access to Psychiatric Hospital Care for Elderly and Disabled Medicare Beneficiaries
- Susan L. Ettner
- … show all 1 hide
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Purpose: Compare Medicare beneficiaries admitted to public, private not-for-profit, and for-profit psychiatric hospitals. Methods: Administrative data on all beneficiaries admitted to psychiatric hospitals in 1990 were used to estimate multinomial logit models of treatment in for-profit or private not-for-profit (vs. public) hospitals, controlling for patient characteristics. Results: Women and beneficiaries with worse geographic access to public hospitals, better access to private hospitals, or comorbidities were more likely to be treated in private hospitals. Blacks, rural residents, and beneficiaries who were disabled, had previous psychiatric hospitalizations, or a primary diagnosis of schizophrenia were less likely to be treated in private hospitals. Residents of lower-income areas were less likely to be treated in private not-for-profits. Conclusions: In addition to being essential providers for the uninsured, public hospitals also play an important role in ensuring access to care for Medicare beneficiaries. Public psychiatric hospitals treat a disproportionate share of the sickest, lowest-income, and minority patients. Geographic proximity and bed supply also play an important role in provider choices. Plans to privatize state psychiatric facilities should take these considerations into account.
- Butler, R., & Lewis, M. (1982). Aging and mental health. St. Louis, MO: C. V. Mosby.
- Center for Mental Health Services, Mandersheid, R., et al. (Eds.) (1996). Mental health, United States, 1996. Department of Health and Human Services Publication No. (SMA) 96-3098. Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office.
- Dorwart, R. A., & Schlesinger, M. (1988). Privatization of psychiatric services. American Journal of Psychiatry, 145(5), 543-553.
- Dorwart, R. A., Schlesinger, M., et al. (1991). A national study of psychiatric hospital care. American Journal of Psychiatry, 148(2), 204-210.
- Frank, R. G., & Salkever, D. S. (1994). Nonprofit organizations in the health sector. Journal of Economic Perspectives, 8(4), 129-144.
- Gray, B. H., & McNerney, W. J. (1986). For-profit enterprise in health care: The Institute of Medicine study. New England Journal of Medicine, 314(23), 1523-1528.
- Institute of Medicine (1986). For-profit enterprise in Health care. Washington, D.C.: National Academy Press.
- Levenson, A. I. (1982). The growth of investor-owned psychiatric hospitals. American Journal of Psychiatry, 139(7), 902-907.
- Norton, E. C., & Staiger, D. O. (1994). How hospital ownership affects access to care for the uninsured. RAND Journal of Economics, 25(1), 171-185.
- Olfson, M., & Mechanic, D. (1996). Mental disorders in public, private nonprofit, and proprietary general hospitals. American Journal of Psychiatry, 153(12), 1613-1619.
- Schlesinger, M., & Dorwart, R. A. (1984). Ownership and mental-health services: A reappraisal of the shift towards privately owned facilities. New England Journal of Medicine, 311, 959-965.
- Schlesinger, M., Dorwart, R., et al. (1997). The determinants of dumping: A national study of economically motivated transfers involving mental health care. Health Services Research, 32(5), 567-598.
- Simons, L. S. (1989). Privatization and the mental health system: A private sector view. American Psychologist, 44(8), 1138-1141.
- The Role of the Public Sector in Ensuring Access to Psychiatric Hospital Care for Elderly and Disabled Medicare Beneficiaries
Mental Health Services Research
Volume 1, Issue 1 , pp 21-29
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers-Plenum Publishers
- Additional Links
- Psychiatric hospitals
- public sector
- mental health services
- Susan L. Ettner (1)
- Author Affiliations
- 1. Department of Medicine, University of California at Los Angeles, Los Angeles, California