MARKET CHANGE AND ACCESS TO INPATIENT PSYCHIATRIC CARE

市场变化和住院精神科护理的获取

• 批准号: 6185799
• 负责人: Jack Needleman
• 金额: $ 33.86万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-05-01 至 2003-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6185799
• 关键词: Medicare /Medicaid; behavioral /social science research tag; clinical research; health care cost /financing; health care facility information system; health care policy; health care quality; health insurance; health services research tag; hospital length of stay; hospital utilization; hospitals; human data; managed care; medical indigency; mental health services; psychiatric patient care; public health

With the scaling back of public state psychiatric hospitals, general hospitals have become a major site of psychiatric inpatient care. While public hospitals play a disproportionate role in caring for Medicaid patients and the uninsured, data from the mid- 1980's show that nonprofit and for-profit general and psychiatric hospitals contributed substantially to the care of these patients. The changing market, notably the increase in competitiveness among insurers and health plans and aggressive negotiations by the plans of rates with hospitals has increased the financial pressures on hospitals and may be encouraging them to reduce the car they provide to Medicaid and uninsured patients. Prior studies of access to inpatient psychiatric care have not adequately addressed the question of whether this has occurred because they have aggregate hospital level data and overhead periods prior to those in which the greatest cost pressure occurred. Our research will use state patient discharge abstract data sets from 1987 to 1997 to: 1) determine the extent have relative admission rates and patient days per capita in different payer classes (including self-pay) changed over time; 2) determine whether, over time, self-pay and Medicaid patients have been shifted from private hospitals to public general hospitals and the pardon this imposes on these hospitals; and 3) determine whether the care self-pay and Medicaid pateints receive in hospitals differs from that of privately insured patients and whether differences in treatment are greater in private hospitals than public hospitals or have increased over time. We will examine the association of these changes to variations in the level of hospital competition, growth of managed care, and state policy change. WE will use discharge and financial data from California, Massachusetts, and Washington, augmented with data from the AHA and Census.

随着公立精神病医院的缩减，综合医院已成为精神病住院治疗的主要场所。虽然公立医院在照顾医疗补助病人和没有保险的人方面扮演着不成比例的角色，但20世纪80年代中期的数据显示，非营利性和营利性的综合医院和精神病院对这些病人的护理做出了很大的贡献。不断变化的市场，特别是保险公司和健康计划之间的竞争力增强，以及费率计划与医院的积极谈判，增加了医院的财政压力，并可能鼓励它们减少向医疗补助计划和没有保险的病人提供的汽车。先前关于获得住院精神病治疗的研究并没有充分解决是否已经发生这种情况的问题，因为他们有医院一级的汇总数据和在发生最大成本压力之前的管理费用期。我们的研究将使用1987年至1997年的国家患者出院摘要数据集：1)确定不同付款人类别（包括自付）的相对住院率和人均住院天数随时间变化的程度；2)确定随着时间的推移，自费和医疗补助患者是否从私立医院转移到公立综合医院，以及这对这些医院施加的赦免；3)确定自费和医疗补助患者在医院接受的护理是否与私人保险患者不同，以及私立医院的治疗差异是否大于公立医院或随着时间的推移而增加。我们将研究这些变化与医院竞争水平的变化、管理式护理的增长和国家政策变化之间的关系。我们将使用来自加利福尼亚州、马萨诸塞州和华盛顿州的排放和财务数据，并辅以美国心脏协会和人口普查的数据。