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Community mental health program efficiency

B H McFarland1, D A Bigelow, J Smith

  • 1Department of Psychiatry, Oregon Health Sciences University, Portland 97201, USA.

Administration and Policy in Mental Health
|July 1, 1997
PubMed
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Community mental health centers in a capitated payment system showed no difference in client outpatient enrollment length. However, agency expenditures varied significantly due to scale and practice styles, impacting efficiency.

Area of Science:

  • Health Services Research
  • Mental Health Policy
  • Healthcare Economics

Background:

  • Severe mental illness (SMI) often involves frequent state hospitalizations.
  • Community mental health centers (CMHCs) aim to provide continuous outpatient care.
  • Capitation models are increasingly used for SMI services.

Purpose of the Study:

  • To evaluate the impact of a capitated payment system on CMHCs serving SMI clients.
  • To assess variations in agency expenditures and client enrollment length.
  • To identify factors contributing to efficiency differences among CMHCs.

Main Methods:

  • Quasi-experimental study involving six urban CMHCs.
  • Participants: SMI clients with frequent state hospital use.

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  • Outcome measures: Length of outpatient enrollment and agency expenditures over 18 months.

    • Main Results:

    • No significant difference in client outpatient enrollment length was observed across the six CMHCs.
    • Agency expenditures varied more than threefold during the study period.
    • Economies of scale and differing practice styles explained expenditure variations.

    Conclusions:

    • Capitation models may not inherently standardize CMHC efficiency or outcomes for SMI clients.
    • Variations in practice styles significantly influence cost-efficiency in mental health services.
    • Further research is needed to optimize payment systems for SMI care.