Comparing quality of mental health care for public-sector and privately insured populations.
OBJECTIVE
This study examined the methodological difficulties of comparing quality of care in large health care systems. It demonstrated methods for measuring quality of mental health care and, using these measures, compared patients from Department of Veterans Affairs (VA) hospitals with privately insured patients.


METHODS
Individuals receiving VA inpatient mental health care during the first six months of each fiscal year from 1993 to 1997 were identified from discharge abstracts. A similar cohort of privately insured individuals was identified using MEDSTAT's MarketScan database from 1993 to 1995. Individuals in both cohorts were tracked for six months after discharge. Length of stay, readmission rates, and access to outpatient services were calculated.


RESULTS
The private sector outperformed VA on most quality measures, although differences were modest and can likely be explained by the greater severity of illness and social disadvantages of VA patients. Readmission rates increased considerably over time in the private sector, whereas they declined for VA patients. Quality measures varied by diagnosis, with VA performing better than the private sector in treating patients diagnosed with substance abuse and mental disorders not elsewhere classified but worse in treating patients diagnosed with depression.


CONCLUSIONS
Although the private sector modestly outperformed VA on most quality measures, VA treats a more troubled population, and it improved markedly over time compared with the private sector. As health systems strive to reduce costs of care, methods for comparing and evaluating the quality of care become increasingly important. However, methodological challenges remain substantial.
Leslie
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Northeast Program Evaluation Center, Connecticut-Massachusetts VA Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut 06516, USA. douglas.leslie@yale.edu
Rosenheck
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D000328:Adult; D000368:Aged; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007358:Insurance, Psychiatric; D007902:Length of Stay; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D010359:Patient Readmission; D017149:Private Sector; D017150:Public Sector; D011785:Quality Assurance, Health Care; D014481:United States