Cross-System Service Use Among VA Mental Health Patients Living in Philadelphia

  • Rani A. Desai
  • Robert A. Rosenheck
  • Aileen Rothbard


There are few published studies of cross-system use of multiple systems of mental health care. This study examines use of VA and non-VA services in Philadelphia County. Results indicated that rates of cross-system use overall are fairly low (16 to 17% of patients across all years), are generally declining over time, and account for a small proportion of total all-system costs (4%). Veterans who used more VA inpatient services also used more non-VA services, and veterans who used fewer VA outpatient services used more non-VA services, indicating that cross-system use may be a quality indicator for the accessibility or acceptability of outpatient care.

cross-system use health services utilization Medicaid beneficiaries mental health services 


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  1. Desai, R.A., & Rosenheck, R.A. (2000). The interdependence of mental health service systems: The effects of VA mental health funding on veterans' use of state mental health inpatient facilities. The Journal of Mental Health Policy and Economics, 3, 61–67.PubMedGoogle Scholar
  2. Dickey, B., Fisher, W., Siegel, C., Altaffer, F., & Azeni H. (1997). The cost and outcomes of communitybased care for the seriously mentally ill. Health Services Research, 32(5), 599–614.PubMedGoogle Scholar
  3. Hoff, R.A., & Rosenheck, R.A. (1998). Long-term patterns of service use and cost among patients with both psychiatric and substance abuse disorders. Medical Care, 36(6), 835–843.PubMedGoogle Scholar
  4. Hoff, R.A., & Rosenheck, R.A. (2000). Cross-system service use among psychiatric patients: Data from the Department of Veterans Affairs. The Journal of Behavioral Health Services and Research, 27(1), 98–106.Google Scholar
  5. Ma, C., & McGuire, T.G. (1998). Costs and incentives in a behavioral health carve-out. Health Affairs, 17(2), 53–69.Google Scholar
  6. Rosenheck, R.A., Frisman, L., & Essock, S. (in press).Impact of VA bed closures on use of state psychiatric services.Google Scholar
  7. Rosenheck, R.A., & Stolar, M. (1998). Access to public mental health services: Determinants of population coverage. Medical Care, 36(4), 503–512.PubMedGoogle Scholar
  8. Schlesinger, M., Dorwart, R., Hoover, C., & Epstein, S. (1997). The determinants of dumping: A national study of economically motivated transfers involving mental health care. Health Services Research, 32(5), 561–590.PubMedGoogle Scholar

Copyright information

© Human Sciences Press, Inc. 2001

Authors and Affiliations

  • Rani A. Desai
    • 1
    • 2
  • Robert A. Rosenheck
    • 3
  • Aileen Rothbard
    • 4
  1. 1.Northeast Program Evaluation Center, VA ConnecticutWest Haven
  2. 2.Department of PsychiatryYale University School of MedicineUSA
  3. 3.Northeast Program Evaluation Center, VA Connecticut. Department of PsychiatryYale University School of MedicineUSA
  4. 4.Center for Mental Health Policy and Services Research, Department of PsychiatryUniversity of Pennsylvania Health SystemUSA

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