PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of hsresearchLink to Publisher's site
 
Health Serv Res. 1997 December; 32(5): 599–614.
PMCID: PMC1070217

The cost and outcomes of community-based care for the seriously mentally ill.

Abstract

OBJECTIVE: To examine the cost-effectiveness of community-based mental health care. DATA SOURCES/STUDY SETTING: Administrative data from Medicaid and the Massachusetts Department of Mental Health; primary data from 144 psychiatrically disabled adult Medicaid beneficiaries who lived in Boston, central Massachusetts, and western Massachusetts. STUDY DESIGN: A cross-sectional observational study compared the costs and outcomes of treatment in three different types of public mental health service systems. DATA COLLECTION/EXTRACTION METHODS: Beneficiaries, randomly sampled from outpatient mental health programs, were interviewed about their mental health status. All their acute treatment and long-term continuing care for the preceding year were abstracted from Medicaid and Department of Mental Health files. Costs were extracted from Medicaid paid claims and from Department of Mental Health contracts and other financial documents. PRINCIPAL FINDINGS: Clients in the region allocating a greater proportion of its Department of Mental Health budget to community support services used far fewer hospital days, resulting in lower per person treatment expenditures. Outcomes, however, were not significantly different from outcomes of clients in the other regions. For all regions, substance abuse comorbidity increased hospitalization and total treatment costs. An individual-level cost-effectiveness analysis identified western Massachusetts (community-based care) as significantly more cost effective than the other two regions. CONCLUSIONS: Systems with stronger community-based orientation are more cost effective.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.6M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Carling PJ. Major mental illness, housing, and supports. The promise of community integration. Am Psychol. 1990 Aug;45(8):969–975. [PubMed]
  • Dickey B, Azeni H. Persons with dual diagnoses of substance abuse and major mental illness: their excess costs of psychiatric care. Am J Public Health. 1996 Jul;86(7):973–977. [PubMed]
  • Dickey B, Wagenaar H, Stewart A. Using health status measures with the seriously mentally ill in health services research. Med Care. 1996 Feb;34(2):112–116. [PubMed]
  • Geller JL. "Anyplace but the state hospital": examining assumptions about the benefits of admission diversion. Hosp Community Psychiatry. 1991 Feb;42(2):145–152. [PubMed]
  • Geller JL, Fisher WH, Wirth-Cauchon JL, Simon LJ. Second-generation deinstitutionalization, I: The impact of Brewster v. Dukakis on state hospital case mix. Am J Psychiatry. 1990 Aug;147(8):982–987. [PubMed]
  • Goldman HH, Morrissey JP, Ridgely MS, Frank RG, Newman SJ, Kennedy C. Lessons from the program on chronic mental illness. Health Aff (Millwood) 1992 Fall;11(3):51–68. [PubMed]
  • Hermann RC, Dorwart RA, Hoover CW, Brody J. Variation in ECT use in the United States. Am J Psychiatry. 1995 Jun;152(6):869–875. [PubMed]
  • Schlesinger M, Dorwart RA, Pulice RT. Competitive bidding and states' purchase of services: the case of mental health care in Massachusetts. J Policy Anal Manage. 1986;5(2):245–263. [PubMed]
  • Shore MF, Cohen MD. Observations from the program on chronic mental illness. Health Aff (Millwood) 1992 Fall;11(3):227–233. [PubMed]
  • Siegel C, Laska E, Meisner M. Statistical methods for cost-effectiveness analyses. Control Clin Trials. 1996 Oct;17(5):387–406. [PubMed]
  • Stein LI, Test MA. Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Arch Gen Psychiatry. 1980 Apr;37(4):392–397. [PubMed]
  • Tessler R, Gamache G. Continuity of care, residence, and family burden in Ohio. Milbank Q. 1994;72(1):149–169. [PubMed]
  • Wennberg JE, Freeman JL, Culp WJ. Are hospital services rationed in New Haven or over-utilised in Boston? Lancet. 1987 May 23;1(8543):1185–1189. [PubMed]
  • Wennberg J, Gittelsohn A. Variations in medical care among small areas. Sci Am. 1982 Apr;246(4):120–134. [PubMed]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust