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Does system reform reduce geographic variation in mental health system performance
Greg A Greenberg1, Robert A Rosenheck
1Northeast Program Evaluation Center, VAMC West Haven, CT 06516, USA. greg.greenberg@yale.edu
The Psychiatric Quarterly
|August 6, 2005
Summary
Major system reform did not reduce regional variation in health services. For mental health performance measures, variation increased for most aspects of care, indicating system reform may worsen disparities.
Area of Science:
- Health Services Research
- Healthcare Management
- Mental Health Services Research
Background:
- Significant regional disparities in healthcare utilization are well-documented for both general and mental health services.
- The impact of major system reforms on these regional variations remains largely unexplored.
Purpose of the Study:
- To investigate whether major system reform influences regional variation in health service use within the Department of Veterans Affairs (VA) healthcare system.
- To analyze trends in regional performance measures during a period of significant system-wide changes.
Main Methods:
- Utilized data from the Department of Veterans Affairs (VA) covering 22 regional networks from 1996 to 2001.
- Examined 21 mental health performance measures, calculating the coefficient of variation to assess regional disparities.
Main Results:
- Regional variation increased for 16 out of 21 mental health performance measures during the study period.
- For 12 of these measures, the increase in regional variation was slight, but the overall trend indicates a lack of reduction.
Conclusions:
- Major system reform within the VA healthcare system did not consistently reduce regional variation in service use.
- The findings suggest that system reforms may, in some cases, exacerbate regional disparities in mental health care delivery.