Mental Health Services Research

, Volume 1, Issue 1, pp 21–29 | Cite as

The Role of the Public Sector in Ensuring Access to Psychiatric Hospital Care for Elderly and Disabled Medicare Beneficiaries


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.

Psychiatric hospitals Medicare public sector privatization mental health services 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Butler, R., & Lewis, M. (1982). Aging and mental health. St. Louis, MO: C. V. Mosby.Google Scholar
  2. 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.Google Scholar
  3. Dorwart, R. A., & Schlesinger, M. (1988). Privatization of psychiatric services. American Journal of Psychiatry, 145(5), 543-553.Google Scholar
  4. Dorwart, R. A., Schlesinger, M., et al. (1991). A national study of psychiatric hospital care. American Journal of Psychiatry, 148(2), 204-210.Google Scholar
  5. Frank, R. G., & Salkever, D. S. (1994). Nonprofit organizations in the health sector. Journal of Economic Perspectives, 8(4), 129-144.Google Scholar
  6. 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.Google Scholar
  7. Institute of Medicine (1986). For-profit enterprise in Health care. Washington, D.C.: National Academy Press.Google Scholar
  8. Levenson, A. I. (1982). The growth of investor-owned psychiatric hospitals. American Journal of Psychiatry, 139(7), 902-907.Google Scholar
  9. 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.Google Scholar
  10. Olfson, M., & Mechanic, D. (1996). Mental disorders in public, private nonprofit, and proprietary general hospitals. American Journal of Psychiatry, 153(12), 1613-1619.Google Scholar
  11. 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.Google Scholar
  12. 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.Google Scholar
  13. Simons, L. S. (1989). Privatization and the mental health system: A private sector view. American Psychologist, 44(8), 1138-1141.Google Scholar

Copyright information

© Plenum Publishing Corporation 1999

Authors and Affiliations

  1. 1.Department of MedicineUniversity of California at Los AngelesLos Angeles
  2. 2.Department of Medicine, Division of General Internal Medicine and Health Services ResearchUniversity of California at Los AngelesLos Angeles

Personalised recommendations