Access to public mental health services: determinants of population coverage.
Access to public mental health services: determinants of population coverage.
复制标题
获得公共精神卫生服务：人口覆盖率的决定因素。
DOI：
10.1097/00005650-199804000-00006
复制
发表时间：
1998
期刊：
影响因子：
3
通讯作者：
Marilyn Stolar
中科院分区：
文献类型：
--
作者：
Robert A. Rosenheck;Marilyn Stolar
目标
这项研究检查了影响获得退伍军人管理局心理健康服务的因素。
方法
来自国家退伍军人事务部数据库和1990年十年一次的人口普查的数据被用来估计退伍军人事务部精神卫生服务的使用率在每个美国县（n = 3,156）在所有美国退伍军人和三个亚群定义的资格和临床状态。在标准的多变量分析和使用分层线性模型技术检查的自变量包括县级社会人口特征（年龄、种族和收入）;“无人管理”的服务系统特征（不受退伍军人事务部项目经理直接控制的项目，例如，从住所到退伍军人事务部和非退伍军人事务部服务的距离，非退伍军人事务部服务的本地供应）;和“管理”服务系统因素（由退伍军人事务项目经理直接控制的因素，例如，人均退伍军人事务资助水平和退伍军人事务服务提供效率）。
结果
总共有2.0%的美国退伍军人使用退伍军人事务部的心理健康服务。超过三分之一（36%）的利用率的差异是由社会人口因素解释，8%是由非管理服务系统因素解释，7%是由管理服务系统因素解释，各亚组之间的差异。退伍军人事务部和非退伍军人事务部系统之间的替代效应得到证明，似乎是诊断特异性的。
结论
人均供资水平和有效的服务提供与获得精神卫生服务的机会增加显著相关。卫生系统的绩效评估和管理的影响进行了讨论。
OBJECTIVES
This study examined factors that affect access to Veterans Administration mental health services.
METHODS
Data from national Veterans Affairs databases and the 1990 Decennial Census were used to estimate rates of Veterans Affairs mental health service use in each US county (n = 3,156) among all US veterans and in three subpopulations defined by eligibility and clinical status. Independent variables examined in standard multivariate analyses and using hierarchical linear modeling techniques included county-level sociodemographic characteristics (age, race, and income); "unmanaged" service system characteristics (those not directly controlled by Veterans Affairs program managers, eg, distance from residence to Veterans Affairs and to non-Veterans Affairs services, local supply of non-Veterans Affairs services); and "managed" service system factors (those directly controlled by Veterans Affairs program managers, eg, per capita Veterans Affairs funding level and the efficiency of Veterans Affairs service delivery).
RESULTS
Altogether, 2.0% of US veterans used Veterans Affairs mental health services. More than one third (36%) of the variance in utilization was explained by sociodemographic factors; 8% was explained by unmanaged service system factors and 7% was explained by managed service system factors, with variations among subgroups. Substitution effects were demonstrated between Veterans Affairs and non-Veterans Affairs systems and appeared to be diagnosis-specific.
CONCLUSIONS
Both per capita funding levels and efficient service delivery were significantly associated with increased access to mental health services. Implications for health system performance assessment and management are discussed.