The Precursors and Impacts of Psychiatric Facility Closure

描述（由申请人提供）：在过去十年中，有相当数量的私立精神病住院医院关闭。1995年至2004年间，近40%的私立专科精神病医院关闭。尽管如此，目前还没有一项关于私立精神病住院治疗关闭的决定因素或影响的全国性研究。在这一时期，国家精神病医院数量减少的幅度较小，可能是由于前几年国家能力大幅下降。在此期间，许多综合医院的精神科也关闭了。一方面，这种关闭可能反映了过去几十年来一直在发生的向门诊护理的总体转变。另一方面，这可能是由于报销不足，使得精神科住院治疗在经济上可行而不切实际。如果精神科住院治疗在经济上不可行，就会出现太多的关闭，获得治疗的机会就会受到损害。美国的大部分医疗保健都是由私营公司提供的；无论是非盈利机构还是营利性机构。不管所有权是什么，如果企业无法承担提供医疗服务的成本，这个体系就无法运转。我们建议研究住院精神病治疗的提供和可及性：1)关闭是由于“缺乏需求”还是“缺乏报销”；2)关闭是否导致了通过急诊科或由法院指导的精神病入院所定义的可及性问题。虽然研究封闭的决定因素是一种直接的定量分析，但研究封闭对通道的影响更难以单独使用定量方法进行研究。因此，我们建议对经历过大型医院关闭的市场进行定性研究，以充分了解大型医院关闭的影响。定性研究将补充定量研究，旨在衡量关闭对通道的影响。我们的研究将集中在受公共和私人设施关闭影响的市场组合上。关闭公共设施和关闭私人设施之间可能存在重大差异。在社区中存在足够的替代护理之后，公共设施可能会关闭。相比之下，私人设施的关闭发生在该设施在财政上不再可行的时候，因此可能是也可能不是社区其他选择的质量和数量的函数。

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.