The Precursors and Impacts of Psychiatric Facility Closure

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DESCRIPTION (provided by applicant): There have been a substantial number of private inpatient psychiatric hospital closures over the past decade. Close to 40% of the private specialty psychiatric hospitals closed between 1995 and 2004. Despite this, there has not been a national study of the determinants or the effect of private inpatient psychiatric care closure. The reduction in the number of state psychiatric hospitals was less dramatic during this time period, likely due to the fact that state capacity declined significantly in earlier years. A large number of psychiatric units in general hospitals also closed during this period. On the one hand, this closure may reflect a general shift towards outpatient care that has been occurring over the past several decades. On the other hand, it may be a result of poor reimbursement which makes financially viable of psychiatric inpatient care impracticable. If inpatient psychiatric care is not financially viable too much closure would occur and access to care would be compromised. Most of the health care in the United States is delivered by private firms; whether they be nonprofit or for-profit facilities. Regardless of ownership, the system cannot function if firms cannot cover the costs of delivering care. We propose to study the delivery of inpatient psychiatric care and access 1) whether closure is due to 'lack of demand' or instead 'lack of reimbursement' and 2) whether closure has led to access problems as defined by psychiatric admissions through the emergency department or directed the a court of law. While studying the determinants of closure is a straightforward quantitative analysis, studying the effect of closure on access is more difficult to study solely using a quantitative approach. Thus, we propose to perform of qualitative study of markets that have experienced a major hospital closure to fully understand the implications of a closure of a major facility. The qualitative study will complement a quantitative study designed to measure the effect of closure on access. Our study will focus on a mix of markets that have been affected by the closure of both public and private facilities. There is likely to be a crucial difference between the closure of public and private facilities. Public facility closure is likely to occur after adequate alternative care exists in the community. In contrast, private facility closure occurs when the facility is no longer financially viable and thus may or may not be a function of the quality and quantity of alternatives in the community.