Racial/Ethnic Disparities in Admissions to Public and Private Psychiatric Inpatient Settings: The Effect of Managed Care

  • Kermit Crawford
  • William H. Fisher
  • Melissa McDermeit


This study investigates the effect of managed care on access patterns among people of color who are severely and persistently mentally ill. The distribution of admissions to public and private psychiatric hospitals was compared for African-American, Asian, Latino, and white case managed clients of the Massachusetts Department of Mental Health before and after implementation of Medicaid managed mental health care in October 1997. Managed care appears to have increased access to private services across all racial and ethnic groups, although admissions of non-white patients were still more likely to take place in publicly operated settings. These data suggest that equalizing access to putatively better inpatient treatment settings may be an externality of managed care.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Borenstein, D.B. (1990). Debate: Managed care: A means of rationing psychiatric treatment. Hospital & Community Psychiatry, 41, 1095-1098.Google Scholar
  2. Callahan, J.J., Shepard, D.S., Beinecke, R.H., Larson, M.J., & Cavanaugh, C. (1995). Mental health/substance abuse in managed care: The Massachusetts Medicaid experience. Health Affairs, 41, 173-184.Google Scholar
  3. Dickey, B., Normand, S.L.T., Norton, E.C., Azeni, H., & Fisher, W.H. (1996). Managing the care of schizophrenia: Lessons from a four-year Massachusetts Medicaid Study. Archives of General Psychiatry, 53, 945-932.Google Scholar
  4. Dickey, B., Norton, E.C., Normand, S.L.T., Azeni, H., Fisher, W.H., & Altaffer, F. (1995). Massachusetts Medicaid managed health care reform: Treatment for the psychiatrically disabled. Advances in Health Economics and Health Services Research, 15, 99-116.Google Scholar
  5. Dorwart, R.A., & Epstein, S. (1993). Privatization and mental health care: A fragile balance. Westport, CT: Auburn House.Google Scholar
  6. Fisher, W.H., Dorwart, R.A., Schlesinger, M., Epstein, S., & Davidson, H. (1992). The role of general hospitals in the privatization of inpatient treatment for serious mental illness. Hospital & Community Psychiatry, 43, 1114-1119.Google Scholar
  7. Fisher, W.H., Lindrooth, R., Norton, E.C., & Dickey, B. (in press). How managed care organizations develop selective contracting networks for psychiatric inpatient care: A case study. Inquiry.Google Scholar
  8. Fisher, W.H., White, C.L., Geller, J.L., & Altaffer, F. (1994). Predicting public vs. private hospitalization in psychiatric emergencies. Adminstration and Policy in Mental Health, 21, 449-462.Google Scholar
  9. Hadley, T.R., Schinnar, A.R., & Rothbard, A. (1994). Managed mental health care in the private sector. In S. Feldman (Ed.), Managed mental health services (pp. 45-60). Springfield, IL: Charles C. Thomas.Google Scholar
  10. Hu, T., Snowden, L.R., Jerrell, J.M., & Nguyen, T.D. (1991). Ethnic populations in public mental health: Services choice and level of use. American Journal of Public Health, 81, 1429-1434.Google Scholar
  11. Joint Commission on Mental Illness and Health. (1961). Action for mental health. New York, NY: Basic Books.Google Scholar
  12. Krause, E.A. (1977). Power and illness: The political sociology of health and medical care. New York, NY: ElsevierGoogle Scholar
  13. Keill, S. (1980). Psychiatric care: A new role for hospitals. Hospitals, 54, 67-70.Google Scholar
  14. Lebensohn, Z. (1980). General hospital psychiatry USA: Retrospect and prospect. Comprehensive Psychiatry, 21, 500-509.Google Scholar
  15. Manderscheid, R.W., & Barrett, S.A. (Eds.). (1987). Mental health, United States, 1987 (DHHS Publication No. ADM 87-1518). Washington, DC: U.S. Government Printing Office.Google Scholar
  16. Minkoff, K. (1994). Community mental health in the nineties: Public sector managed care. Community Mental Health Journal, 30, 317-321.Google Scholar
  17. Robertson, S. (1974). Changing the medical care system. New York, NY: Praeger.Google Scholar
  18. Starr, P. (1982). The social transformation of American medicine. New York, NY: Basic Books.Google Scholar
  19. Stelovich, S. (1992). Managed care and major mental illness: An overview. In J.L. Feldman & R.J. Fitzpatrick (Eds.), Managed mental health care: Adminstrative and clinical issues (pp. 249-260). Washington, DC: American Psychiatric Press.Google Scholar
  20. Weimer, S.R. (1990). Managed mental health care: Myths and realities in the 1990s. Hospital & Community Psychiatry, 41, 1092-1098.Google Scholar
  21. White, C.L., Bateman, W.H., Fisher, W.H., & Geller, J.L. (1995). Factors associated with admission to public and private hospitals from a psychiatric emergency screening site. Psychiatric Services, 46, 467-472.Google Scholar

Copyright information

© Human Sciences Press, Inc. 1998

Authors and Affiliations

  • Kermit Crawford
    • 1
  • William H. Fisher
    • 2
  • Melissa McDermeit
    • 2
  1. 1.Boston University School of MedicineUSA
  2. 2.University of Massachusetts Medical SchoolUSA

Personalised recommendations