title: The impact of realignment on utilization and cost of community-based mental health services in California.
abstract: Decentralization of California's public mental health system under program realignment has changed the utilization and cost of community-based mental health services. This study examined a sample of 75,951 users, representing 1.5 million adults who visited California's public mental health services during a 6-year period (FY 1988-1990 and FY 1992-1994). Regression analysis was performed to examine cost and utilization reduction over time, across regions, and across psychiatric diagnoses. Overall utilization and cost of community-based mental health services dropped significantly after the implementation of realignment. They were significantly lower for (a) 24-hour services in the urban industrialized Southern Region and (b) outpatient services in the agricultural Central Region of the state. Users diagnosed with mood disorders took a greater portion, but were associated with significantly less treatment and cost than other users in the post-realignment period. When local communities bear the financial risks and rewards, they find more efficient methods of delivering community-based mental health services.
authors.affiliation: Health Policy and Management Division of the School of Public Health, University of California at Berkeley, 94720-7360, USA. rscheff@uclink4.berkeley.edu
authors.forename: R
authors.initials: R
authors.lastname: Scheffler
authors.forename: A
authors.initials: A
authors.lastname: Zhang
authors.forename: L
authors.initials: L
authors.lastname: Snowden
mesh_terms: D000328:Adult; D002140:California; D003156:Community Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D005260:Female; D005380:Financing, Government / Q000458:organization & administration*; D017048:Health Care Costs; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D011057:Politics; D011635:Public Health Administration